The majority (60%) of patients with newly diagnosed non-Hodgkin lymphoma (NHL) are ≥60 years old. Treatment-related toxicity is more common in older adults with NHL, which can result in them benefitting less from treatment. Currently, there is no validated instrument that can predict toxicity in older adults with NHL who are receiving chemotherapy. However, Pallawi Torka, MD, Memorial Sloan Kettering Cancer Center, Montvale, New Jersey, and colleagues performed a prospective study on whether a geriatric assessment (GA) or its component measures can predict toxicity in this patient population, and whether changes in GA during and after treatment correlate with toxicity.

For the study, the researchers performed a GA using the following instruments: a medical outcomes study (MOS) for activities of daily living (ADLs), Older Americans Resources and Services (OARS) subscales for instrumental activities of daily living (IADLs) and physical health comorbidities, a timed up and go (TUG) test, and others. The number of falls a patient experienced as well as their weight loss percentage were also included in the data. Participants also self-reported their Karnofsky Performance Status (KPS).

The assessment was performed in four phases: (1) before patients received pre-phase therapy (if applicable), (2) before patients began a new chemotherapy regimen, (3) within 7 days prior to each treatment cycle (up to 6), and (4) 1 month (+/- 10 days) after patients completed therapy. Severe toxicity was the primary outcome of the study, and the following scenarios could be considered: (1) if the patient was hospitalized during or within 30 days following chemotherapy, (2) if there was a dose delay or reduction to a dose intensity for ≤80% of the planned dose intensity, (3) if there was a discontinuation of chemotherapy due to toxicity, and (4) if the patient died. The secondary endpoints were grade 3 or higher non-hematologic toxicity and grade 4 or higher hematologic toxicity.

The study included 194 patients with NHL who were ≥60 years old (median age of 75 years [IQR 68-81 years]) and starting a new chemotherapy regimen. The majority of the participants had diffuse large B- cell lymphoma (DLBCL) (72%), advanced stage disease (75%), and had received the R-CHOP treatment regimen (71%). In addition, 42% of the patients were women.

Dr Torka and colleagues found that the median scores for ADL and IADL were 85 (IQR 46-95) and 14 (IQR 13-14), respectively. More than half of the patients experienced severe toxicity (57%), with 25% having grade 3 or higher non-hematologic toxicity and 38% having grade 4 or higher hematologic toxicity. For the overall survival (OS), the 2-year OS rate was 83% (CI 78%, 89%) and the 5-year OS rate was 78% (CI 71%, 84%). The assessment also showed that patients who experienced severe toxicity were older in age (76 vs 72 years, P = .007). This older group also had lower ADL scores (80 vs 90, P = .014) and lower patient-reported KPS (80 vs 90, P < .001).

For TUG results, an abnormal TUG test, which was defined as ≥12 sec, was found in 29% of patients. Those who had an abnormal TUG at baseline also had a higher incidence of severe toxicity when compared to those with normal TUG (72% vs 51%, P = .01). The different treatment regimens also had an impact on the incidence of severe toxicity experienced by the patients. For instance, patients on a R-EPOCH regimen had a higher incidence of severe toxicity events compared to those on other regimens (82% vs 54%, P = .012). Also, patients on an R-CHOP regimen had less severe toxicity events compared to those who were receiving other treatments (52% vs 70%, P = .023).

Overall, the researchers found that several components of the GA were useful in predicting severe treatment-related toxicity in older adults with NHL who are receiving chemotherapy. In particular, low ADL score, self-reported KPS, and abnormal TUG were associated with severe treatment-related toxicity for this patient group. Dr Torka and colleagues suggest that abnormal TUG time should be incorporated in treatment decision-making for these patients, as the TUG test is objective and easy to administer. The authors are currently working on evaluating the correlation between dynamic changes in geriatric assessment before each treatment cycle and toxicities.

Source: 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: 2023 ASH Annual Meeting & Exposition; December 9-12, 2023; San Diego, CA, and virtual; Abstract 70.