Longitudinal Patient-Reported Outcomes in Older Adults With Aggressive Lymphomas Receiving Chemoimmunotherapy

Abstract

Background: Aggressive non-Hodgkin lymphoma (aNHL) is more common in older adults. Although chemoimmunotherapy can yield durable remissions, it is also associated with significant toxicities. Despite this, longitudinal studies assessing patient-reported outcomes (PROs) with chemoimmunotherapy in this population are lacking.

Patients and methods: We conducted a longitudinal study of 105 adults aged ≥65 years who initiated up-front chemoimmunotherapy for aNHL across 2 academic centers and their community affiliates between September 2020 and January 2023. Quality of life (QoL) was assessed using the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym), physical symptoms via the revised Edmonton Symptom Assessment Scale (ESAS-r), and psychological symptoms with the Hospital Anxiety and Depression Scale (HADS). Assessments were performed at baseline; 6, 12, 18, and 24 weeks post-therapy initiation; and 1 year post-therapy initiation. Frailty status was evaluated at baseline using the Fondazione Italiana Linfomi geriatric assessment (GA) and the Vulnerable Elders Survey-13 (VES-13). Linear mixed models were used to examine the trajectory of PROs over time, and linear regression was employed to identify factors associated with QoL at 1 year.

Results: The median patient age was 73 years (range, 64-99), with 41.9% aged ≥75 years. Most patients (53.8%) had an age-adjusted International Prognostic Index (IPI) of 2/3, and 70.5% had diffuse large B-cell lymphoma. Overall, 50.5% and 45.7% were identified as frail or vulnerable on GA and VES-13, respectively. Longitudinal QoL, physical symptoms, anxiety, and depression all significantly improved over time (all P≤.001). QoL improved regardless of age category (65-74 vs ≥75 years) or frailty status. In multivariate analyses, being married/living with partner was associated with better QoL at 1 year (β=11.6; P=.026), whereas frailty on GA (β= -9.90; P=.036) was associated with worse QoL.

Conclusions: Older adults with aNHL receiving chemoimmunotherapy experienced significant and durable improvement in QoL, physical symptoms, and psychological health up to 1 year post-therapy initiation, irrespective of age or frailty status. However, frailty was associated with worse QoL at 1 year post-therapy initiation. These findings underscore the importance of integrating GAs into treatment planning for older adults with aNHL.