Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May;22(5):554-560.
doi: 10.1634/theoncologist.2016-0260. Epub 2017 Apr 13.

A Host-Dependent Prognostic Model for Elderly Patients with Diffuse Large B-Cell Lymphoma

Katsuhiro Miura  1 , Jun Konishi  2 , Takaaki Miyake  3 , Masanori Makita  2 , Atsuko Hojo  4 , Yasufumi Masaki  5 , Masatoshi Uno  6 , Jun Ozaki  7 , Chikamasa Yoshida  8 , Daigo Niiya  9 , Koichi Kitazume  10 , Yoshinobu Maeda  11 , Jun Takizawa  12 , Rika Sakai  13 , Tomofumi Yano  9 , Kazuhiko Yamamoto  14 , Kazutaka Sunami  2 , Yasushi Hiramatsu  15 , Kazutoshi Aoyama  16 , Hideki Tsujimura  17 , Jun Murakami  18 , Yoshihiro Hatta  19 , Masatoshi Kanno  20
Affiliations

A Host-Dependent Prognostic Model for Elderly Patients with Diffuse Large B-Cell Lymphoma

Katsuhiro Miura et al. Oncologist. 2017 May.

Abstract

Background: Decision-making models for elderly patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) are in great demand.

Patients and methods: The Society of Lymphoma Treatment in Japan (SoLT-J), in collaboration with the West-Japan Hematology and Oncology Group (West-JHOG), collected and retrospectively analyzed the clinical records of ≥65-year-old patients with DLBCL treated with R-CHOP from 19 sites across Japan to build an algorithm that can stratify adherence to R-CHOP.

Results: A total of 836 patients with a median age of 74 years (range, 65-96 years) were analyzed. In the SoLT-J cohort (n = 555), age >75 years, serum albumin level <3.7 g/dL, and Charlson Comorbidity Index score ≥3 were independent adverse risk factors and were defined as the Age, Comorbidities, and Albumin (ACA) index. Based on their ACA index score, patients were categorized into "excellent" (0 points), "good" (1 point), "moderate" (2 points), and "poor" (3 points) groups. This grouping effectively discriminated the 3-year overall survival rates, mean relative total doses (or relative dose intensity) of anthracycline and cyclophosphamide, unanticipated R-CHOP discontinuance rates, febrile neutropenia rates, and treatment-related death rates. Additionally, the ACA index showed comparable results for these clinical parameters when it was applied to the West-JHOG cohort (n = 281).

Conclusion: The ACA index has the ability to stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of elderly patients with DLBCL treated with R-CHOP. The Oncologist 2017;22:554-560 IMPLICATIONS FOR PRACTICE: Currently, little is known regarding how to identify elderly patients with diffuse large B-cell lymphoma who may tolerate a full dose of chemotherapy or to what extent cytotoxic drugs should be reduced in some specific conditions. The Society of Lymphoma Treatment in Japan developed a host-dependent prognostic model consisting of higher age (>75 years), hypoalbuminemia (<3.7 g/dL), and higher Charlson Comorbidity Index score (≥3) for such elderly patients. This model can stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of these patients and thus help clinicians in formulating personalized treatment strategies for this growing patient population.

Keywords: Comorbidity; Diffuse large B‐cell lymphoma; Geriatric assessment; Hypoalbuminemia; Personalized medicine; R‐CHOP chemotherapy.

PubMed Disclaimer

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
CONSORT diagram of the data collection. A total of 836 patients from the SoLT‐J (n = 555) and the West‐JHOG (n = 281) were evaluated as the training set and validation set, respectively. Abbreviations: CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; SoLT‐J, Society of Lymphoma Treatment in Japan; West‐JHOG, West‐Japan Hematology and Oncology Group.
Figure 2.
Figure 2.
Overall survival according to the risk groups stratified by the ACA index in the SoLT‐J cohort (A) and West‐JHOG cohort (B). Abbreviations: ACA index, Age, Comorbidities, and Albumin index; SoLT‐J, Society of Lymphoma Treatment in Japan; West‐JHOG, West‐Japan Hematology and Oncology Group.
Figure 3.
Figure 3.
Mean relative total dose and relative dose intensity of doxorubicin and cyclophosphamide in each risk group of the ACA index in the Society of Lymphoma Treatment in Japan cohort (A and B) and West‐Japan Hematology and Oncology Group cohort (C and D). Error bars represent standard error. Each p value was calculated by post hoc t test and adjusted by Bonferroni correction. Abbreviations: ACA index, Age, Comorbidities, and Albumin index; NS, not significant.
See this image and copyright information in PMC

References

    1. A predictive model for aggressive non‐Hodgkin's lymphoma . The International Non‐Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med 1993;329:987–994. - PubMed
    1. Sehn LH, Berry B, Chhanabhai M et al. The revised International Prognostic Index (R‐IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B‐cell lymphoma treated with R‐CHOP. Blood 2007;109:1857–1861. - PubMed
    1. Zhou Z, Sehn LH, Rademaker AW et al. An enhanced International Prognostic Index (NCCN‐IPI) for patients with diffuse large B‐cell lymphoma treated in the rituximab era. Blood 2014;123:837–842. - PMC - PubMed
    1. DeSantis CE, Lin CC, Mariotto AB et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014;64:252–271. - PubMed
    1. Lichtman SM. Chemotherapy in the elderly. Semin Oncol 2004;31:160–174. - PubMed

MeSH terms