Evaluating the Comprehensive Geriatric Assessment Model As an Assessment Tool to Predict Chemotoxicity in Elderly Patients with Lymphoma

• Published in: Blood 2024-11, Vol.144 (Supplement 1), p.388-388
• Main Authors: Tang, Xinjie Jonathan, Lee, Joanne Shu Xian, Chan, Esther Hian Li, De Mel, Sanjay, Chee, Yen-Lin, Chng, Wee-Joo, Poon, Michelle Limei, Choong, Shi Hui Clarice, Ooi, Melissa Gaik-Ming
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2024-198867

Elderly patients with hematological malignancies including lymphoma are at greater risk of chemotherapy related adverse events with poorer outcomes compared to younger patients. Conventional assessment such as the Eastern Cooperative Oncology Group (ECOG) performance status scores and the Cancer and Aging Research Group (CARG) Chemotherapy Toxicity Tool may over-estimate the fitness of elderly patients in receiving anti-cancer treatment, hence exposing them to greater risks. This study aims to evaluate the Comprehensive Geriatric Assessment (CGA) model as a tool to identify frail elderly (Asian) patients with lymphoma who are at greater risk of chemo-toxicities, and compare it with ECOG and CARG assessment tools. A prospective analysis was conducted on patients over 65 years of age with newly diagnosed lymphoma receiving chemotherapy. CGA scores were assessed prior to treatment, looking at the following geriatric domains: activities of daily living, falls history, hearing/visual impairment, nutritional assessment, cognition, polypharmacy and psychosocial support. ECOG performance status and CARG scores were also collected. Treatment related adverse events (TRAE) were recorded at each clinical encounter, and classified according to the Common Terminology Criteria for Adverse Events. The relationship between CGA scores, ECOG scores, CARG scores, Overall Survival (OS) and incidence of severe TRAEs (Grades 3 to 5) was evaluated. 104 patients were analyzed, with a median age of 75 years (range 65-93). Diffuse Large B Cell Lymphoma was the most common subtype (72 patients, 69.2%). 29 (27.9%) patients were identified as Fit, 61 (58.7%) as Pre-Frail, and 14 (13.4%) as Frail. Of note, 50% of patients identified as Frail on CGA were also categorized as ECOG 0, whilst 62.3% of Pre-Frail patients were categorized as ECOG 0. Similarly, 28.6% of patients identified as Frail were categorized as Low and Medium risk on CARG scoring, and 14.8% of patients identified as Pre-Frail were also categorized to be Low risk on CARG. An upfront chemotherapy dose reduction strategy was employed in 78.6% of CGA Frail patients, compared to 57.4% and 20.7% of CGA Pre-Frail and Fit patients respectively. 699 severe TRAEs were reported throughout the follow-up duration. Fit patients experienced an average of 4.97 severe TRAEs, whilst Pre-Frail and Frail patients experienced a higher average of 7.26 and 8.00 events respectively (P-value=0.165). Severe hematological TRAEs were more common (6