Impact of frailty in survival of older patients with classical Hodgkin lymphoma: A retrospective, multicenter study from the spanish registry of lymphoma (RELINF) of the spanish group of lymphoma (GELTAMO)

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Abstract Introduction. The outcomes of older adults with classical Hodgkin Lymphoma (cHL) have improved in recent decades. However, despite having better treatment strategies and better supportive care, the prognosis remains poor for those aged ≥70 years. Frailty has been associated with poor outcomes and worse tolerance of treatments in older patients with hematological malignancies. Hence, there are recommendations to perform geriatric assessment (GA) and to integrate it into the treatment decision plan, but the implementation in clinical practice is still limited. Methods. We conducted a retrospective, multicenter study in the Spanish Lymphoma Registry (RELINF) of the Spanish Lymphoma Group (GELTAMO). Hereby, we enrolled in this study 673 patients with cHL aged 60 years or above from 46 Spanish centers. We analyzed the impact of comorbidities and frailty on their outcome. We collected baseline patient characteristics, including activities of daily living (ADL), instrumental activities of daily living (IADL), geriatric syndromes, and comorbidities scored with CIRS-G. Statistical analyses were done with R. Results. Median age at diagnosis was 72 years (range 60-93), 57.8% were male, 65.7% were diagnosed with advanced stage, and 43.9% with extranodal involvement. CIRS score was collected in 417 patients, with a median score of 4 (range 0-13). Activities of daily living (ADL) were collected in 569 patients, with 79 (13.9%) of them showing impairments. Instrumental activities of daily living (IADL) were collected in 532 patients, with impairments in 94 (17.7%) of them. Geriatric syndromes were detected in 84 patients (14.4%). In the univariate analyses, age >71 years (HR 1.08, 95%CI 1.06-1.10, p<0.001), previous history of cardiovascular disease (HR 1.79, 95%CI 1.35-2.39, p<0.001), extranodal involvement (HR 1.69, 95%CI 1.28-2.23, p<0.001), advanced stage (HR 4.99, 95%CI 2.18-11.4, p<0.001), ECOG >2 (HR 10.4, 95%CI 6.64-16.2, p<0.001), impairment in ADL (HR 3.78, 95%CI 2.66-5.36, p<0.001), and IADL (HR 3.75, 95%CI 2.65-5.30, p<0.001), presence of geriatric syndromes (HR 1.83, 95%CI 1.25-2.68, p=0.002), and cardiac (HR 1.85, 95%CI 1.28-22.65, p=0.001), and psychiatric (HR 1.80, 95%CI 1.21-2.67, p=0.004) comorbidities had a negative impact in the survival. In lab tests, only absolute lymphocyte counts (ALC), hemoglobin, albumin and ESR had impact in survival. With regard to treatments, no differences were seen among all therapies. Only palliative regimens showed shorter survival (HR 11.5, 95%CI 7.73-17.2, p<0.001). In the multivariate analysis, age, ECOG, anemia, geriatric syndromes and palliative therapy had an impact on OS. Conclusions. Functional reserve and resilience have an impact on the outcome of older patients with cHL. Frailty assessment through a GA should be incorporated in the evaluation of older patients with cHL to identify those patients at higher risk. Better and safer treatment strategies are needed to overcome the poorer prognosis of this group of patients.

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