Older patients with non-Hodgkin lymphoma (NHL) who take potentially inappropriate medications increase the risk of adverse survival impacts, according to research presented at the 2017 ASCO Annual Meeting (June 2-6, 2017; Chicago, IL).
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Data records show that survival outcomes for older patients with advanced NHL are significantly inferior to those of younger patients. A common belief is that tumor biology explains this trend, but comorbidities, polypharmacy, and use of potentially inappropriate medications such as anticholinergics and benzodiazepines may also play a key role.
Richard Jirui Lin, MD, PhD, Langone Medical Center, New York University (New York, NY), and colleagues conducted a study to examine the possible association of polypharmacy and potentially inappropriate medication use with progression-free survival (PFS), overall survival (OS), and treatment-related toxicities. Researchers analyzed 171 patients (median age, 70 years; range, 65-77) with aggressive NHL aged 60 or older treated at multiple hospitals from 2009 to 2014.
At baseline, researchers reported that 46% of patients used more than 4 medications and 47% of patients used a minimum of 1 potentially inappropriate medication. Forty-three percent of patients received an adequate relative dose intensity of first-line chemotherapy. Sixty-five percent experienced grade 3 or higher toxicities.
After a median follow-up of 28 months, median PFS and OS were not reached for the entire cohort. Polypharmacy and potentially inappropriate medication use were associated with shortened PFS and OS in a univariable log-rank test. In a multivariate analysis, potentially inappropriate medication use served as an independent predictor of PFS (HR, 2.81; P = .005) and OS (HR, 3.12; P = .003).
Additionally, researchers noted that potentially inappropriate medication use and albumin level were significantly associated with grade 3 or higher toxicities (OR, 1.02; P .014).
Authors of the study affirmed that reduced survival could have been due to drug-drug interactions during intensive chemotherapy, which could have led to increased toxicities or hindered the delivery of full dose chemotherapy. Nonetheless, “Our findings support the use of evidence-based geriatric principles to guide meticulous medication management to improve outcome disparity for these patients,” Dr Lin said.—Zachary Bessette
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