LONG BEACH, CA — Oncologists balance the most effective treatment against the likelihood of adverse effects for every patient with cancer. Generally, the assumption is that older patients and those with more comorbidities and poorer performance status will experience more negative effects, including potentially fatal toxicity, from aggressive treatment. A study presented at the American Society of Clinical Oncology annual meeting in June calls into question this assumption for at least some patients and specific malignancies.
“It is well known that age, stage, and performance status are important prognostic factors in predicting survival of patients diagnosed with lymphoid malignancies,” said Helen Ma, MD, and her colleagues at the University of California, Irvine. They explored the impact of those factors on veterans receiving care for lymphoma within the VHA, many of whom are elderly, have multiple comorbidities, and poor performance status.1
The retrospective study evaluated records from 221 veterans who received care at the VA Long Beach CA, Healthcare System for diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic leukemia (CLL), follicular lymphoma (FL), marginal zone lymphoma (MZL), mantle cell lymphoma (MCL), and peripheral T-cell lymphoma (PTCL) between January 2008 and December 2021. The researchers focused on clinically relevant hematological and non-hematological adverse events and death from lymphoma compared to death from other causes. Additional analyses looked at the impact on outcomes of aggressive vs. indolent disease, stage, age at diagnosis, and performance status.
Eighty-five patients had DLBCL or PTCL, which were considered aggressive lymphomas, while 149 had more indolent malignancies, including CLL, FL, MZL and MCL. Using the Eastern Cooperative Oncology Group (ECOG) scale, researchers classified patients who scored 0-2 as having good performance status and those scoring 3 or 4 as having poor performance status.
Contrary to expectations, the team found that aggressiveness of the lymphoma and its stage did not predict clinically relevant adverse events in patients receiving first-line therapy. Neither did patient age at diagnosis nor performance status, researchers noted.
Further, advanced age and poor performance status were not found to correlate with a statistically greater risk of dying from lymphoma rather than other causes. Patients with more aggressive disease and more advanced stage, however, had four times the risk of dying from lymphoma vs. other causes in a multivariate analysis (hazard ratio [HR] 4.1; p < 0.001, 95% CI 2.2-7.8 and 3.1; p = < 0.0001, 95% CI 1.7-5.5).
These findings could affect treatment decisions for veterans and others with lymphoma. “The fact that performance status may not predict the development of [adverse events] with first-line therapy for lymphoid malignancies is relevant to clinical decision-making,” the researchers concluded, though they noted that confirmatory studies are needed.
- Ma H, Ricks-Oddie J, Streja E, Eapen A, Gupta P. Factors associated with death from lymphoma in a single-center study. J Clin Oncol. 2022;40,(suppl 16; abstr e19566).