The Role of Geriatric Assessment Tools in Enhancing Oncology Care: ASH 2024

The treatment of older adults with non-Hodgkin lymphoma (NHL), including diffuse large B-cell lymphoma (DLBCL), presents unique challenges due to age-related physiological changes and associated comorbidities. A pair of recent studies featured at The American Society of Hematology (ASH) Annual Meeting & Exposition provides critical insights into the prognostic utility of geriatric assessment (GA) tools and their role in tailoring therapy to improve patient outcomes.^1,2

Advancing geriatric assessment in non-Hodgkin lymphoma, diffuse large B-cell lymphoma.

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Geriatric Assessment Enhances DLBCL Prognosis

A study involving 619 patients aged over 65 years with newly diagnosed DLBCL examined the prognostic value of GA tools compared with traditional performance status measures.¹ The retrospective analysis, conducted between 2010 and 2022, revealed that the median age of participants was 73 years, with the majority receiving anthracycline (AC)-based chemotherapy combined with immunotherapy.

Notably, treatment with AC-based therapy was associated with significantly improved progression-free survival (PFS), with a median of 100 months, as well as overall survival (OS) when compared with non-AC-based treatments. Additionally, older age and higher Eastern Cooperative Oncology Group (ECOG) performance scores ranging from 2 to 4 were identified as factors that predicted poorer PFS and OS outcomes.

Insights from Prospective Pilot Cohort

In a cohort of 66 patients, a comprehensive geriatric assessment (CGA) revealed important disparities that the ECOG scale overlooked. While ECOG classified 85% of patients as fit, the CGA identified 62% as pre-frail and 12% as frail. This assessment was more closely aligned with chemotherapy toxicity risk scores (CARG-TT) compared with ECOG. Additionally, pre-frail and frail patients experienced higher rates of severe treatment-related adverse events (TRAEs), even with dose reduction strategies in place.

The survival outcomes also highlighted significant differences; frail patients had a median OS of 9 months, while the OS for pre-frail and fit patients had not yet been reached. These findings underscore the value of CGA in providing a more nuanced understanding of frailty and the associated risks of chemotherapy toxicity, suggesting its potential to guide therapy adjustments for elderly patients with DLBCL. Integrating geriatric assessment tools into routine practice could enhance treatment personalization and improve patient outcomes.

Timed Up and Go Test Predicts Chemotherapy Toxicity

A second study prospectively evaluated the predictive value of the Timed Up and Go (TUG) test for severe toxicity (STox) in a cohort of 194 older adults with NHL undergoing chemotherapy. The findings indicated that patients with an abnormal TUG time of 12 seconds or more were significantly more likely to experience STox. Moreover, every additional second in baseline TUG time was associated with an 11% increase in the odds of experiencing STox across all chemotherapy cycles.

Increases of 5 seconds and 10 seconds further raised these odds by 70% and 180%, respectively. The study also found that abnormal TUG times were correlated with higher grades of both hematologic and non-hematologic toxicities, in addition to lower PFS and OS rates. The authors stated that these implications suggest that the TUG test is a tool that may reliably predict toxicity risk in older patients with NHL, enhancing treatment safety and optimizing therapeutic strategies in clinical practice.

Future Directions for Geriatric Assessment Tools

The studies highlight the importance of incorporating geriatric assessment tools into oncology care for older adults. While CGA provides a comprehensive evaluation of frailty and treatment risk, the TUG test offers a quick, actionable measure of chemotherapy tolerance. Together, these tools present a compelling case for personalized approaches in managing elderly patients with NHL, ultimately aiming to balance efficacy with safety.

References

1. Tang XJ, Lee JSX, Chan EHL, et al. Outcomes of Elderly Patients with DLBCL and Utility of Geriatric Assessment Tools to Predict Chemotoxicity. Blood. 2024;144(Supplement 1):3660.

2. Torka P, Drill E, Ganesan N, et al. A Prospective Geriatric Assessment (GA) Study Predicting Toxicities in Older Adults (OA) with Non-Hodgkin Lymphoma (NHL): Timed up and Go Test (TUG) Time Emerges As a Functional Vital Sign. Blood. 2024;144(Supplement 1):4474.