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

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

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 languageEnglish
Article number101538
JournalJournal of Geriatric Oncology
Volume14
Issue number6
DOIs
StatePublished - Jul 2023

Keywords

  • CLL
  • Functional status
  • Geriatric assessment
  • Nutritional status
  • Treatment outcome

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