The Use Of Modified Cumulative Illness Rating Scale-Geriatric In Elderly With Non-Hodgkin's Lymphoma

Objective:The evaluation of comorbidity is increasingly used in the diagnosis and treatment of elderly with cancer abroad.However,there is not such a research in China.This article made a preliminary study to investigate the relationship between chemotherapy adverse reactions and comorbidity of elderly with non-Hodgkin's lymphoma using the Modified Cumulative Illness Rating-Geriatric scale(MCIRS-G),and explored its clinical value.Methods:The subjects came from the department of Oncology in First Affiliated Hospital of Anhui Medical University.The patients with non-Hodgkin's lymphoma who received CHOP from October,2006 to September,2007 were divided into the elderly group(≥65 years) and the control group(＜65 years).MCIRS-G was used to measure the comorbidity and CTCAE Version 3.0 was used to evaluate the adverse reactions.The MCIRS-G score,the chemotherapy adverse reactions and curative effect of the two groups were compared.The difference of chemotherapy adverse reaction rates were analyzed according to the MCIRS-G score,KPS score or age.All the data was processed through the software SPSS13.0. Results:1.Until September,2007,31 old patients in the elderly group,including 17 men and 14 women,were enrolled.Their age ranged from 65 to 81 and the median age was 68. Among them,29 patients received chemotherapy.There were 21 male and 10 female patients in the control group,and all of them received chemotherapy.The controls' age range from 18 to 63 and the median age was 41.2.The MCIRS-G score of the elderly was significantly higher than that of the control group(P＜0.05).28 patients in the elderly group and 13 patients in the control group had the combordity.The most common combordity in the elderly was hypertension, while it was chronic gastritis in the control group.3.The main adverse reactions of the patients were myelotoxicity,gradeⅠ-Ⅱfatigue and gradeⅠ-Ⅱgastrointestinal toxicity.Cardiac toxicity and neurotoxicity of chemotherapy were slight,and no case was discontinuted chemotherapy because of severe adverse events.The incidences of leukopenia and fatigue were different between the two groups(P＜0.05).4.CR/CR_U was significantly different(P＜0.05 ) between the two groups,while there was no significantly differences in response ratio(CR/CR_U+PR).5.The incidences of myelotoxicity(P=0.041) and fatigue(P=0.049) increased in the elderly group in parallel with the increased score of MCIRS-G,while no differences were observed according to KPS score or age. Conclusion:CHOP regimen is safe and effective to the elderly patients with NHL.The MCIRS-G score which could evaluate the comorbidity of elderly was associated with the incidence of the adverse reactions.The assessment of comorbidity by MCIRS-G score provided a better selection of appropriate chemotherapeutical agents for the treatment of elderly patients,and the main toxicity caused by drugs in an organ system should be avoided. There is no correlation between the score of MCIRS and KPS.MCIRS-G could be recommended to guide the treatment of elderly with non-Hodgkin's lymphoma.