Table 4.
Geriatric assessment-guided treatment interventions in older adults with NHL.
| Study | Geriatric Assessment Domains | Categorization | Approach | Outcomes | Treatment toxicity |
|---|---|---|---|---|---|
| Bernardi et al. [60] | Age, IADL, IADL, hepatic/renal function | Fit: ADL and IADL score of at least 5, with intact hepatic, renal function and hemopoietic reserve; Intermediate dose group - IADL<5, or age > 80; Frail: dependent on ≥1 ADL, ≥3 comorbidities, or ≥ 1 geriatric syndromes | Curative intent with full dose in “fit” group; 75% of planned dose in intermediate-dose group and palliative approach in “frail” group | Entire cohort: ORR - 90%; CR 79% | Not available |
| Spina et al. [61] | Comorbidities, ADL, IADL | Fit: no grade 3 comorbidities (or < 3 grade 2 comorbidities), an ADL score of 6, and/or an IADL score of 7 or 8; Unfit - no grade 3 comorbidities (or 3–5 grade 2 comorbidities), an ADL score of 5, and/or an IADL score of 5 or 6; Frail: ≥1 grade 3 comorbidities (or > 5 grade 2 comorbidities), an ADL score < 5, or an IADL score < 5. | Two-step approach: Step 1: Regimen based on comorbidities - No Comorbidities: RCHOP; Comorbidities (Cardiac, Neuropathy, Diabetes): R-CEOP/CEOP, R-CVP/CVP, R-CHP/CHP; R-CHO/CHO Step 2: Dosing based on functional status - Full dose (100%): ADL (6), IADL (7–8); Intermediate dose (75%): ADL (5), IADL (5–6); Reduced dose (50%): ADL/IADL <5 | CR rate: 85% in fit versus 72% in unfit and 85% in frail (p = 0.34); 5-year OS: 76% for fit versus 53% for unfit and 29% for frail (p = 0.001) | Severe toxicity reported in 31% in fit versus 48% and 58% in unfit and frail, respectively p =0.11; Treatment-related mortality: (fit - 5%, unfit - 9% and frail - 11%); |
| Olivieri et al. [62] | Age, comorbidities, geriatric syndromes, ADL independence | Fit: Age < 85, no grade 2 comorbidities or geriatric syndromes and ADL independence; With comorbidities: presence of comorbidities; Frail: age ≥ 85, ≥1 ADL dependence, ≥1 geriatric syndrome, ≥3 grade 2 or ≥ 1 CIRS-G grade 3 comorbidity | Fit: RCHOP21 With comorbidities: RCHOP21 (with liposomal doxorubicin) Frail: mini-RCHOP21 | CR Rate was 81.5% in the fit group versus 63.6% in patients with comorbidities (unfit) and 60% in frail; Improved OS in fit vs unfit/frail (p = 0.00933), but no difference between OS between unfit and frail (p = 0.63) | Treatment-related mortality: 1.9% (fit) versus 9.1% (with comorbidities) versus 6.7% (frail). |
| Lastra-German et al. [63] | Unintentional weight loss, physical exhaustion, low physical activity, slowness, weakness | One point for each positive item: fit: 0 points, unfit.: 1–2 points, frail: 3 points | Fit patients: R-CHOP; Unfit patients: R-choP (adjusted to 80% of total R-CHOP dose; Frail patients: R-COP | CR rate was 66.6% in fit, versus 78.3% in unfit and 40% in frail patients; Median OS was 22.5 months in fit, vs 21 months and 11 months in unfit and frail groups respectively. | No significant difference in grade 3/4 hematological toxicity (83.3% in fit versus 65.2% in unfit and 45% in frail, p = 0.192) |
| Bai et al. [20] | ADL, IADL, age, comorbidities (modified CIRS-G) | Fit, unfit and frail groups based on Tucci et al. [23] Study combined unfit and frail into one group for therapeutic interventions. | Fit patients: R-CHOP; Unfit/frail patients: R-CHOP (with 50% anthracycline dose), R-COP or R-miniCHOP | CR rate was 84.4% versus 51.5% (p = 0.002). Three-year OS was 91% versus 69% (statistical significance unknown). | No significant difference in treatment-related toxicity between fit and unfit/frail groups (grade 3/4 hematological toxicity - 51.1% vs 54.5%, p > 0.05) |
ADL: Activities of Daily Living, IADL: Instrumental Activities of Daily Living; CIRS-G – Comorbidities Illness Rating Scale-Geriatrics; ORR – overall response rate; CR- complete response; OS – overall survival; R- rituximab; CEOP - cyclophosphamide, epirubicin, vincristine, and prednisone; CHO - cyclophosphamide, doxorubicin, and vincristine; CHOP - cyclophosphamide, doxorubicin, vincristine, and prednisone; CHP - cyclophosphamide, doxorubicin, and prednisone; CVP - cyclophosphamide, vincristine, and prednisone, COP - cyclophosphamide, vincristine, and prednisone.