Longitudinal Patient-Reported Outcomes in Older Adults With Aggressive Lymphomas Receiving Chemoimmunotherapy
Harvard Medical School, Boston, MA
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Harvard Medical School, Boston, MA
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Division of Lymphoma, Dana-Farber Cancer Institute, Boston, MA
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Division of Lymphoma, Dana-Farber Cancer Institute, Boston, MA
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Harvard Medical School, Boston, MA
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Division of Lymphoma, Dana-Farber Cancer Institute, Boston, MA
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Harvard Medical School, Boston, MA
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Harvard Medical School, Boston, MA
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Harvard Medical School, Boston, MA
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Division of Lymphoma, Dana-Farber Cancer Institute, Boston, MA
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Division of Lymphoma, Dana-Farber Cancer Institute, Boston, MA
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Division of Lymphoma, Dana-Farber Cancer Institute, Boston, MA
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Harvard Medical School, Boston, MA
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Harvard Medical School, Boston, MA
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Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Duke School of Medicine, Durham, NC
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Division of Lymphoma, Dana-Farber Cancer Institute, Boston, MA
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Harvard Medical School, Boston, MA
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Background: Aggressive non-Hodgkin lymphoma (aNHL) is more common in older adults. Although chemoimmunotherapy can yield durable remissions, it is also associated with significant toxicities. Despite this, longitudinal studies assessing patient-reported outcomes (PROs) with chemoimmunotherapy in this population are lacking. Patients and Methods: We conducted a longitudinal study of 105 adults aged ≥65 years who initiated up-front chemoimmunotherapy for aNHL across 2 academic centers and their community affiliates between September 2020 and January 2023. Quality of life (QoL) was assessed using the Functional Assessment of Cancer Therapy–Lymphoma (FACT-Lym), physical symptoms via the revised Edmonton Symptom Assessment Scale (ESAS-r), and psychological symptoms with the Hospital Anxiety and Depression Scale (HADS). Assessments were performed at baseline; 6, 12, 18, and 24 weeks post–therapy initiation; and 1 year post–therapy initiation. Frailty status was evaluated at baseline using the Fondazione Italiana Linfomi geriatric assessment (GA) and the Vulnerable Elders Survey-13 (VES-13). Linear mixed models were used to examine the trajectory of PROs over time, and linear regression was employed to identify factors associated with QoL at 1 year. Results: The median patient age was 73 years (range, 64–99), with 41.9% aged ≥75 years. Most patients (53.8%) had an age-adjusted International Prognostic Index (IPI) of 2/3, and 70.5% had diffuse large B-cell lymphoma. Overall, 50.5% and 45.7% were identified as frail or vulnerable on GA and VES-13, respectively. Longitudinal QoL, physical symptoms, anxiety, and depression all significantly improved over time (all P≤.001). QoL improved regardless of age category (65–74 vs ≥75 years) or frailty status. In multivariate analyses, being married/living with partner was associated with better QoL at 1 year (β=11.6; P=.026), whereas frailty on GA (β= −9.90; P=.036) was associated with worse QoL. Conclusions: Older adults with aNHL receiving chemoimmunotherapy experienced significant and durable improvement in QoL, physical symptoms, and psychological health up to 1 year post–therapy initiation, irrespective of age or frailty status. However, frailty was associated with worse QoL at 1 year post–therapy initiation. These findings underscore the importance of integrating GAs into treatment planning for older adults with aNHL.
Submitted July 19, 2024; final revision received September 30, 2024; accepted for publication October 15, 2024. Published online February 19, 2025.
O.O. Odejide and A. El-Jawahri contributed equally to this work.
Author contributions: Research design: Johnson, Abramson, LaCasce, Odejide, El-Jawahri. Data collection: Johnson, Abramson, LaCasce, Armand, Barnes, Merryman, Soumerai, Hochberg, Takvorian, Jacobson, Crombie, Fisher, Schwartz, Friedman, Odejide. Patient enrollment & data entry: Stacey, Yang, Coffey. Statistical analysis: Johnson, El-Jawahri. Data analysis & interpretation: Johnson, Odejide, El-Jawahri. Writing—original draft: Johnson, Odejide, El-Jawahri. Writing—review & editing: All authors.
Data availability statement: The datasets generated and/or analyzed during the present study are available from the corresponding author on reasonable request.
Disclosures: Dr. Johnson has disclosed serving as a consultant for AstraZeneca, Seagen, ADC Therapeutics, AbbVie, Bristol Myers Squibb, and Incyte; and receiving grant/research support from AstraZeneca, Incyte, Novartis, and Oncternal Therapeutics. Dr. Abramson has disclosed serving as a consultant for AbbVie, ADC Therapeutics, AstraZeneca, BeiGene, Bristol Myers Squibb, Cellectar Biosciences, Caribou Biosciences, Celgene, Genentech, Gilead Sciences, Incyte, Interius BioTherapeutics, Janssen, Lilly, Novartis, Roche, Seagen, and Takeda Pharmaceuticals; and receiving institutional grant/research support from Bristol Myers Squibb, Celgene, Cellectis, Genentech, Merck, Mustang Bio, Regeneron, Seagen, and Takeda Pharmaceuticals. Dr. LaCasce has disclosed serving as a consultant for Seagen and Kite Pharma. Dr. Armand has disclosed serving as a consultant for Merck, Bristol Myers Squibb, ADC Therapeutics, Genmab, Enterome, Genentech/Roche, ATB Therapeutics, and Foresight Diagnostics; and receiving grant/research support from Regeneron, Kite Pharma, Merck, Bristol Myers Squibb, Adaptive Biotechnologies, Genentech, IGM Biosciences, and AstraZeneca. Dr. Merryman has disclosed serving as a consultant for Genmab, Adaptive Biotechnologies, Bristol Myers Squibb, AbbVie, Intellia Therapeutics, and Epizyme; and receiving grant/research support from Bristol Myers Squibb, Merck, Genentech/Roche, and Genmab. Dr. Jacobson has disclosed serving as a consultant for Kite/Gilead, Bristol Myers Squibb/Celgene, Novartis, ImmPACT Bio, ADC Therapeutics, AbbVie, AstraZeneca, Caribou Biosciences, Galapagos, Appia Bio, Synthekine, Janssen, and Sana Biotechnology. Dr. Crombie has disclosed serving as a consultant for Regeneron, ADC Therapeutics, Seagen, and Kite Pharma; and receiving grant/research support from Merck, Genentech/Roche, Bayer, and AbbVie. Dr. Soumerai has disclosed serving as a consultant for AstraZeneca, Bristol Myers Squibb, Genentech/Roche, and Loxo@Lilly; and receiving institutional grant/research support from Adaptive Biotechnologies, BeiGene, BostonGene, Genentech/Roche, GSK, Moderna, Takeda Pharmaceuticals, and TG Therapeutics. Dr. Schwartz has disclosed serving as a consultant for Sanofi/Genzyme. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This work was supported by funding from the Lymphoma Research Foundation (Lymphoma Scientific Research Mentoring Program; P.C. Johnson).
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7082. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
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