| Objective: To compare the predictive effects of IACA,original Geriatric Assessment(oGA)and simplified Geriatric Assessment(sGA)on treatment response,tolerance and prognosis in elderly patients with lymphoma.Methods: A retrospective analysis was performed on newly diagnosed lymphoma patients aged ≥60 years who were admitted to Dalian Central Hospital from January 1,2019 to October 31,2022.They were grouped according to IACA,original Geriatric assessment(oGA)and simplified Geriatric assessment scale(sGA).To evaluate the differences in treatment response,tolerance and prognosis among patients grouped by three different scales.Results: A total of 98 patients with lymphoma aged ≥60 years were included,including 56 males and 42 females.The median age was 70 years(60-88years).According to IACA,there were 23 patients(23.5%)in low-risk group,38patients(38.8%)in intermediate-risk group and 37 patients(37.7%)in high-risk group.The objective response rate(ORR)of patients in the low-risk group was higher than intermediate-risk group and high-risk group(90.9%,75% and 50%,respectively,p=0.003).The 2-year probability of progression-free survival(PFS)in the low-risk group was higher than intermediate-risk and high-risk groups(84.7%,72.2% and40.5%,respectively,p=0.001).The 2-year probability of overall survival(OS)in the low-risk group was significantly higher than intermediate-risk group and high-risk group(95%,90.1% and 52.6%,respectively,p<0.001).The incidence of dose reduction in high-risk group(51.4%)was significantly higher than that in low-risk group(8.7%)and intermediate-risk group(18.4%),p<0.001.The incidence of hematological adverse reactions above grade 3 in high-risk group(64.9%)was higher than that in low-risk group(43.5%)and intermediate-risk group(36.8%),p=0.044.The incidence of tertiary infection in high-risk group(16.2%)was significantly higher than that in low-risk group(4.3%)and intermediate-risk group(0%),p=0.021.According to original geriatric assessment(oGA),there were 31(31.6%)patients in the fit group,29(29.6%)patients in the unfit group,and 38(38.8%)patients in the frail group.The ORR of the fit group was higher unfit and frail groups(93.4%,69.2%and 50%,respectively,p=0.001).The 2-year probability of PFS rate in fit group was higher than unfit group and frial group,(84.9%,68.9% and 37.7%,respectively,p=0.001).The 2-year OS rate of the fit group was higher than unfit group and frial group(96.2%,90.7% and 56.9%,respectively,p<0.001).The incidence of dose reduction in unfit group(34.5%)and frial group(34.2%)was higher than fit group(16.1%),but there was no significant difference in the three groups(p=0.179).The incidence of adverse reactions in unfit and frial groups was higher than fit,but there was no statistical significance in the three groups(p>0.05).According to the simplified geriatric assessment(sGA),there were 51 patients(52.0%)in the fit group,22 patients(22.4%)in the unfit group,and 25 patients(25.6%)in the frial group.ORR in fit group was higher than that in unfit group and frial group,which were 85.1%,54.5% and 52.2%,respectively(p=0.004).The 2-year PFS rate in the fit group was higher than unfit group and frial group,which were80.3%,44.3% and 45.5%(p=0.004),and the 2-year OS rate in the fit group was higher than unfit group and frial group,which were 94.9%,74.9% and 51.7%(p<0.001).The incidence of dose reduction in unfit group(31.3%)and fial group(44%)was higher than fit group(19.6%),but there was no significant difference among the three groups(p=0.081).The incidence of tertiary infection was higher in frial group(20%)than fit group(2%)and unfit group(4.5%)(p=0.012).The incidence of PICC thrombosis in frial group(8%)was higher than that fit group(0%)and unfit group(0%),p=0.047.The IACA was better than sGA in predicting PFS in the unfit group(intermediate-risk group)(p=0.047).There was no difference in OS prediction among three groups.There was no difference in ORR,CR,PR and treatment tolerance among the three scales.Conclusions: The three comprehensive geriatric assessment scales can be used to classify elderly patients with lymphoma into three groups,which is easy to operate and highly feasible.All three comprehensive geriatric assessment can identify frial not detected by ECOG,more objectively assess functional status in elderly patients with lymphoma,and predict clinical outcomes.Compared with the three comprehensive geriatric assessment,the IACA has more advantages in predicting PFS. |
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