Geriatric assessment measures are predictive of outcomes in chronic lymphocytic leukemia

P. Connor Johnson; Jennifer A. Woyach; Angela Ulrich; Veronique Marcotte; Ryan D. Nipp; Daniel E. Lage; Ashley M. Nelson; Richard A. Newcomb; Julia Rice; Mitchell W. Lavoie; Christine S. Ritchie; Nancy Bartlett; Deborah M. Stephens; Wei Ding; Carolyn Owen; Richard Stone; Amy S. Ruppert; Sumithra J. Mandrekar; John C. Byrd; Areej El-Jawahri; Jennifer Le-Rademacher; Ashley Rosko

doi:10.1016/j.jgo.2023.101538

Geriatric assessment measures are predictive of outcomes in chronic lymphocytic leukemia

P. Connor Johnson, Jennifer A. Woyach, Angela Ulrich, Veronique Marcotte, Ryan D. Nipp, Daniel E. Lage, Ashley M. Nelson, Richard A. Newcomb, Julia Rice, Mitchell W. Lavoie, Christine S. Ritchie, Nancy Bartlett, Deborah M. Stephens, Wei Ding, Carolyn Owen, Richard Stone, Amy S. Ruppert, Sumithra J. Mandrekar, John C. Byrd, Areej El-JawahriJennifer Le-Rademacher, Ashley Rosko

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Abstract

Introduction: Chronic lymphocytic leukemia (CLL) commonly affects older adults. However, few studies have examined the relationship between baseline geriatric domains and clinical outcomes in this population. Here, we aim to evaluate the use of a comprehensive geriatric assessment in older (>65 years) untreated patients with CLL to predict outcomes. Materials and Methods: We conducted a planned analysis of 369 patients with CLL age 65 or older treated in a phase 3 randomized trial of bendamustine plus rituximab versus ibrutinib plus rituximab versus ibrutinib alone (A041202). Patients underwent evaluations of geriatric domains including functional status, psychological status, social activity, cognition, social support, and nutritional status. We examined associations among baseline geriatric domains with grade 3+ adverse events using multivariable logistic regression and overall survival (OS) and progression-free survival (PFS) using multivariable Cox regression models. Results: In this study, the median age was 71 years (range: 65–87). In the combined multivariable model, the following geriatric domains were significantly associated with PFS: Medical Outcomes Study (MOS) - social activities survey score (hazard ratio [HR] [95% confidence interval (CI)] 0.974(0.961, 0.988), p = 0.0002) and nutritional status (≥5% weight loss in the preceding six months: (HR [95% CI] 2.717[1.696, 4.354], p < 0.001). MOS - social activities score [HR (95% CI) 0.978(0.958, 0.999), p = 0.038] was associated with OS. No geriatric domains were significantly associated with toxicity. There were no statistically significant interactions between geriatric domains and treatment. Discussion: Geriatric domains of social activity and nutritional status were associated with OS and/or PFS in older adults with CLL. These findings highlight the importance of assessing geriatric domains to identify high-risk patients with CLL who may benefit from additional support during treatment.

Original language	English
Article number	101538
Journal	Journal of Geriatric Oncology
Volume	14
Issue number	6
DOIs	https://doi.org/10.1016/j.jgo.2023.101538
State	Published - Jul 2023

Keywords

CLL
Functional status
Geriatric assessment
Nutritional status
Treatment outcome

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Johnson, P. C., Woyach, J. A., Ulrich, A., Marcotte, V., Nipp, R. D., Lage, D. E., Nelson, A. M., Newcomb, R. A., Rice, J., Lavoie, M. W., Ritchie, C. S., Bartlett, N., Stephens, D. M., Ding, W., Owen, C., Stone, R., Ruppert, A. S., Mandrekar, S. J., Byrd, J. C., ... Rosko, A. (2023). Geriatric assessment measures are predictive of outcomes in chronic lymphocytic leukemia. Journal of Geriatric Oncology, 14(6), Article 101538. https://doi.org/10.1016/j.jgo.2023.101538

@article{c3f95b4600894edda0202a9fb395df07,

title = "Geriatric assessment measures are predictive of outcomes in chronic lymphocytic leukemia",

abstract = "Introduction: Chronic lymphocytic leukemia (CLL) commonly affects older adults. However, few studies have examined the relationship between baseline geriatric domains and clinical outcomes in this population. Here, we aim to evaluate the use of a comprehensive geriatric assessment in older (>65 years) untreated patients with CLL to predict outcomes. Materials and Methods: We conducted a planned analysis of 369 patients with CLL age 65 or older treated in a phase 3 randomized trial of bendamustine plus rituximab versus ibrutinib plus rituximab versus ibrutinib alone (A041202). Patients underwent evaluations of geriatric domains including functional status, psychological status, social activity, cognition, social support, and nutritional status. We examined associations among baseline geriatric domains with grade 3+ adverse events using multivariable logistic regression and overall survival (OS) and progression-free survival (PFS) using multivariable Cox regression models. Results: In this study, the median age was 71 years (range: 65–87). In the combined multivariable model, the following geriatric domains were significantly associated with PFS: Medical Outcomes Study (MOS) - social activities survey score (hazard ratio [HR] [95% confidence interval (CI)] 0.974(0.961, 0.988), p = 0.0002) and nutritional status (≥5% weight loss in the preceding six months: (HR [95% CI] 2.717[1.696, 4.354], p < 0.001). MOS - social activities score [HR (95% CI) 0.978(0.958, 0.999), p = 0.038] was associated with OS. No geriatric domains were significantly associated with toxicity. There were no statistically significant interactions between geriatric domains and treatment. Discussion: Geriatric domains of social activity and nutritional status were associated with OS and/or PFS in older adults with CLL. These findings highlight the importance of assessing geriatric domains to identify high-risk patients with CLL who may benefit from additional support during treatment.",

keywords = "CLL, Functional status, Geriatric assessment, Nutritional status, Treatment outcome",

author = "Johnson, {P. Connor} and Woyach, {Jennifer A.} and Angela Ulrich and Veronique Marcotte and Nipp, {Ryan D.} and Lage, {Daniel E.} and Nelson, {Ashley M.} and Newcomb, {Richard A.} and Julia Rice and Lavoie, {Mitchell W.} and Ritchie, {Christine S.} and Nancy Bartlett and Stephens, {Deborah M.} and Wei Ding and Carolyn Owen and Richard Stone and Ruppert, {Amy S.} and Mandrekar, {Sumithra J.} and Byrd, {John C.} and Areej El-Jawahri and Jennifer Le-Rademacher and Ashley Rosko",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier Ltd",

year = "2023",

month = jul,

doi = "10.1016/j.jgo.2023.101538",

language = "English",

volume = "14",

journal = "Journal of Geriatric Oncology",

issn = "1879-4068",

number = "6",

}

Johnson, PC, Woyach, JA, Ulrich, A, Marcotte, V, Nipp, RD, Lage, DE, Nelson, AM, Newcomb, RA, Rice, J, Lavoie, MW, Ritchie, CS, Bartlett, N, Stephens, DM, Ding, W, Owen, C, Stone, R, Ruppert, AS, Mandrekar, SJ, Byrd, JC, El-Jawahri, A, Le-Rademacher, J & Rosko, A 2023, 'Geriatric assessment measures are predictive of outcomes in chronic lymphocytic leukemia', Journal of Geriatric Oncology, vol. 14, no. 6, 101538. https://doi.org/10.1016/j.jgo.2023.101538

TY - JOUR

T1 - Geriatric assessment measures are predictive of outcomes in chronic lymphocytic leukemia

AU - Johnson, P. Connor

AU - Woyach, Jennifer A.

AU - Ulrich, Angela

AU - Marcotte, Veronique

AU - Nipp, Ryan D.

AU - Lage, Daniel E.

AU - Nelson, Ashley M.

AU - Newcomb, Richard A.

AU - Rice, Julia

AU - Lavoie, Mitchell W.

AU - Ritchie, Christine S.

AU - Bartlett, Nancy

AU - Stephens, Deborah M.

AU - Ding, Wei

AU - Owen, Carolyn

AU - Stone, Richard

AU - Ruppert, Amy S.

AU - Mandrekar, Sumithra J.

AU - Byrd, John C.

AU - El-Jawahri, Areej

AU - Le-Rademacher, Jennifer

AU - Rosko, Ashley

PY - 2023/7

Y1 - 2023/7

N2 - Introduction: Chronic lymphocytic leukemia (CLL) commonly affects older adults. However, few studies have examined the relationship between baseline geriatric domains and clinical outcomes in this population. Here, we aim to evaluate the use of a comprehensive geriatric assessment in older (>65 years) untreated patients with CLL to predict outcomes. Materials and Methods: We conducted a planned analysis of 369 patients with CLL age 65 or older treated in a phase 3 randomized trial of bendamustine plus rituximab versus ibrutinib plus rituximab versus ibrutinib alone (A041202). Patients underwent evaluations of geriatric domains including functional status, psychological status, social activity, cognition, social support, and nutritional status. We examined associations among baseline geriatric domains with grade 3+ adverse events using multivariable logistic regression and overall survival (OS) and progression-free survival (PFS) using multivariable Cox regression models. Results: In this study, the median age was 71 years (range: 65–87). In the combined multivariable model, the following geriatric domains were significantly associated with PFS: Medical Outcomes Study (MOS) - social activities survey score (hazard ratio [HR] [95% confidence interval (CI)] 0.974(0.961, 0.988), p = 0.0002) and nutritional status (≥5% weight loss in the preceding six months: (HR [95% CI] 2.717[1.696, 4.354], p < 0.001). MOS - social activities score [HR (95% CI) 0.978(0.958, 0.999), p = 0.038] was associated with OS. No geriatric domains were significantly associated with toxicity. There were no statistically significant interactions between geriatric domains and treatment. Discussion: Geriatric domains of social activity and nutritional status were associated with OS and/or PFS in older adults with CLL. These findings highlight the importance of assessing geriatric domains to identify high-risk patients with CLL who may benefit from additional support during treatment.

AB - Introduction: Chronic lymphocytic leukemia (CLL) commonly affects older adults. However, few studies have examined the relationship between baseline geriatric domains and clinical outcomes in this population. Here, we aim to evaluate the use of a comprehensive geriatric assessment in older (>65 years) untreated patients with CLL to predict outcomes. Materials and Methods: We conducted a planned analysis of 369 patients with CLL age 65 or older treated in a phase 3 randomized trial of bendamustine plus rituximab versus ibrutinib plus rituximab versus ibrutinib alone (A041202). Patients underwent evaluations of geriatric domains including functional status, psychological status, social activity, cognition, social support, and nutritional status. We examined associations among baseline geriatric domains with grade 3+ adverse events using multivariable logistic regression and overall survival (OS) and progression-free survival (PFS) using multivariable Cox regression models. Results: In this study, the median age was 71 years (range: 65–87). In the combined multivariable model, the following geriatric domains were significantly associated with PFS: Medical Outcomes Study (MOS) - social activities survey score (hazard ratio [HR] [95% confidence interval (CI)] 0.974(0.961, 0.988), p = 0.0002) and nutritional status (≥5% weight loss in the preceding six months: (HR [95% CI] 2.717[1.696, 4.354], p < 0.001). MOS - social activities score [HR (95% CI) 0.978(0.958, 0.999), p = 0.038] was associated with OS. No geriatric domains were significantly associated with toxicity. There were no statistically significant interactions between geriatric domains and treatment. Discussion: Geriatric domains of social activity and nutritional status were associated with OS and/or PFS in older adults with CLL. These findings highlight the importance of assessing geriatric domains to identify high-risk patients with CLL who may benefit from additional support during treatment.

KW - CLL

KW - Functional status

KW - Geriatric assessment

KW - Nutritional status

KW - Treatment outcome

UR - http://www.scopus.com/inward/record.url?scp=85162174937&partnerID=8YFLogxK

U2 - 10.1016/j.jgo.2023.101538

DO - 10.1016/j.jgo.2023.101538

M3 - Article

C2 - 37329769

AN - SCOPUS:85162174937

SN - 1879-4068

VL - 14

JO - Journal of Geriatric Oncology

JF - Journal of Geriatric Oncology

IS - 6

M1 - 101538

ER -

Geriatric assessment measures are predictive of outcomes in chronic lymphocytic leukemia

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