Frailty assessment to individualize treatment in older patients with lymphoma

Abstract

Abstract Purpose We present a study analyzing the application of a systematic protocol for specialized comprehensive geriatric assessment (CGA) in patients with lymphoma over 70 years of age, permitting frailty-based patient classification, individualized care recommendations, and treatment personalization.Methods Lymphoma patients over 70 years of age referred to the Geriatric Hematology clinic at Fundación Jiménez Díaz University Hospital (Madrid, Spain) for specialized CGA between 1 May 2016 and 31 March 2021 were included in the study. Patients were referred us a part of our clinical care practice for assessment using a systematic CGA protocol by a qualified geriatrician.Results Ninety-three patients (55.9% women) were included, with a median age of 81.1 years (+/- 5.7). 23 patients (24.7%) were classified as robust (type I), 30 patients (32.3%) as pre-fragile (type II) with potentially reversable deficits, 38 patients (40.9%) as fragile (type III), and only 2 patients (2.2%) as presenting with a poor overall prognosis or requiring palliative care (type IV). All patients received oncospecific treatment, with treatment modifications carried out in 64.5% of patients based on CGA results. Statistically significant differences in overall survival (p 0.002), response to treatment (p < 0.001) and likelihood of increased frailty at the end of treatment (p 0.024) were observed, with type III-IV patients showing worse overall survival, lower response rates, and higher incidence of frailty.Conclusion Performance of standardized, systematic CGA by geriatricians permits older patients with lymphoma to be classified according to frailty, with significant differences in terms of clinical outcomes across groups.