Geriatric Assessment Measures Predict Chemotherapy Toxicity, NHL Survival

Specific subscales of geriatric assessment (GA) tools — including a simple test of the time required to stand from a chair, walk 3 meters, turn around, and sit back in the chair — can predict which patients with non-Hodgkin lymphoma (NHL) will experience chemotherapy toxicities, according to a prospective single-center study presented at ASH Annual Meeting 2023.

“The Timed Up and Go test time was independently associated with incidents of severe treatment related toxicity and should be routinely incorporated in treatment decision-making,” reported lead study author Pallawi Torka, MD, of Memorial Sloan Kettering Cancer Center, in Montvale, New Jersey. “The time is right for incorporating geriatric assessment into practice.”

Toxicity is more common among those aged 60 years and older at diagnosis with NHL. They also have poorer relapse-free and overall survival (OS) than younger patients. Reduced intensity treatment regimens can reduce toxicity but at the cost of reduced disease control, Dr Torka noted.

The research team sought to determine if predictive GA tests might allow tailored treatment reduction and closer monitoring during treatment for patients at high risk of toxicity.

They enrolled 194 English-speaking patients aged 60 years and older who had confirmed NHL diagnoses and were starting a new curative or palliative chemotherapy regimen. Most (72%) of the patients had diffuse large B-cell lymphoma (DLBCL) and 75% had advanced, stage 3 or 4, disease. Most were “relatively fit” at baseline, Dr Torka said.

The researchers used several GA instrument subscales, including, for functional status: the Activities of Daily Living (ADL) subscale of the Medical Outcomes Survey (MOS), the Instrumental Activities of Daily Living (IADL) subscale of the Older Americans Resources and Services (OARS) instrument, patients’ self-reported Karnofsky Performance Scale (KPS) index, number of falls in the past 6 months, and the Timed Up and Go test.

They also measured comorbidity with the Physical Health Section subscale of the OARS, psychological state and cognition with the Mental Health Inventory (MHI)-17 and Blessed Orientation Memory Concentration (BOMC) test, and social activity and support levels using the MOS Social Activity Survey and MOS Social Support Survey. Nutritional status was assessed with the Mini Nutritional Assessment (MNA) instrument and polypharmacy was defined as more than 10 daily medications.

GA was assessed repeatedly:

• At baseline
• Prior to prephase rituximab therapy (for those who received it)
• Prior to initiation of R-CHOP or R-CHOP-like chemotherapy
• Serially during chemotherapy, within 7 days before each of up to 6 cycles
• Approximately 1 month after completing chemotherapy

Importantly, the researchers were unable to determine which patients received treatments off-protocol, Dr Torka cautioned. 

More than half of the patients (110 patient [57%]) experienced toxicity events, including 4 early-induction deaths. High-grade hematologic toxicities occurred in 74 patients (38%), and grade 3 or higher nonhematologic toxicities in one-quarter of patients (49 patients [25%]). At a median follow-up of 4.3 years, median OS was not reached, and the 2-year OS was 83% (95% CI, 78%-89%).

ADL, IADL, patient-reported KPS, and Timed Up and Go time significantly correlated with toxicity events. So did older age and chemotherapy regimen (the latter was just shy of statistical significance at P =.056). But in a multivariate analysis, only Timed Up and Go times were significantly correlated with toxicity events (odds ratio [OR] 1.07; 95% CI, 1.01-1.15; P =.031).

Several GA components were associated with OS: ADL, IADL, KPS, Timed Up and Go, falls, MNA, and polypharmacy. Comorbidities also predicted OS.

“Similar results were observed in the diffuse large B cell lymphoma cohort,” Dr Torka noted. 

Comprehensive GA between each treatment cycle is probably not feasible in clinical practice, Dr Torka said in response to a question immediately after her presentation.

Questions remain about the best GA measures for predicting toxicity and OS, Dr Torka concluded. “The next steps, in my opinion, should include operationalizing some of these [GA] components, perhaps the Timed Up and Go time, in clinical practice to evaluate its performance in the real world and also to start incorporating fitness as a stratification factor — or even inclusion criterion in the design of trials serving older adults with lymphoma.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Torka P, Drill E, Ganesan N, et al. Predicting toxicities in older adults with non-Hodgkin lymphoma (NHL) receiving systemic chemotherapy: a prospective geriatric assessment (GA) study. Presented at ASH 2023. December 9-12, 2023. San Diego, CA. Abstract 70.