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A Multicentric retrospective analysis on clinical outcomes for elderly patients with stage I-II diffuse large b-cell lymphoma
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Abstracts
Conclusion: Elderly patients 70 years or older do not experience more delay in the fast-track cancer programme for H&N cancer at Odense University Hospital. The time to start of treatment for these patients was similar to patients less than 70 years of age and not influenced significantly by comorbidity and performance. Disclosure of interest: None declared. Keywords: Demography, Networks, Policies doi:10.1016/j.jgo.2014.09.066
Haematological cancer in elderly patients P038 DISRUPTION OF THE CLINICAL CARE PATHWAY IN GERIATRIC HEMATOLOGY: IMPACT OF THE GERIATRIC ASSESSMENT N. Signol1,⁎, A. Pham Dang2, J. B. Fargeas1, M. A. Picat3, A. Penot1, C. Vallejo2, T. Dantoine3, D. Bordessoule1 1 Clinical Hematology Department, France 2 Emergency Department 3 Geriatric Medicine Department, CHU Dupuytren, LIMOGES, France Introduction: A study conducted in a university hospital on the years 2005–2006 is interested in the emergency department (ED) access of patients with hematological malignancies (HM). Caring a population of mostly elderly patients, geriatric assessment (GA) was implemented in an clinical hematology department. Objectives: The objective of this work was to assess the impact of GA on disruptor of the care pathway manifested by emergency admissions. Methods: A retrospective analysis based on a sample of 183 patients visits to the ED during 2011 and 2012 and suffering of HM. A comparative analysis based on the age of patients has been established with a cut-off at 70 years. Comparisons were made on repeated ED visits, social and familial status, daily medications, comorbidities, realization of GA. Results: Among the 183 patients included during 2 years, 55,7 % were aged more than 70 years (n = 102/183). 71% (n = 72/102) of elderly patients have benefited from a GA. 51% make at least 2 admissions to emergencies (n = 52/102) and among these, 29% (n = 15/52) were socially isolated, 99% had at least one comorbidity (n = 100/102). 29% (n = 53/102) took more than 6 treatments per day. The hematologic malignancy diagnosis (HM) was known before the emergency admission to the majority of patients: 74.5% (n = 76/ 102). Although these results objectify a real improvement of EG compared to years 2005–2006, 1/3 of old patients with HM has not benefited from a GA. According to the latest French National Cancer Plan, the optimal care pathway in geriatric hematology must associate a customize plan of care, a GA , a social assessment , therapeutic education sessions to prevent and reduce situation of care disruption. Conclusion: Patients suffering of HM coming to the ED are mostly aged more than 70 years. Although the GA is an essential clinical and quality measure, it’s not sufficient to prevent disruption of clinical care pathway: specific hemato-geriatric network seem necessary. Reference: N. Signol et al. .Emergency access to elderly patients suffering from hematologic malignancies in an university hospital. Study based on 175 cases in Limousin, France. SIOG congres 2012. Disclosure of interest: None declared. Keywords: Haematological, Networks doi:10.1016/j.jgo.2014.09.068
Haematological cancer in elderly patients P039 A MULTICENTRIC RETROSPECTIVE ANALYSIS ON CLINICAL OUTCOMES FOR ELDERLY PATIENTS WITH STAGE I-II DIFFUSE LARGE B-CELL LYMPHOMA P. Ciammella1,⁎, A. R. Filippi2, M. Buglione3, G. Simontacchi4, A. Ruffini5, U. Vitolo6, F. Merli5, U. Ricardi7 1 Radiation Oncology Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia 2 Department of Oncology, Radiation Oncology,University of Turin, Torino 3 Radiation Oncology Department, AO Spedali Civili-Istituto del Radio, università degli Studi di Brescia, Brescia 4 Radiotherapy Department, Careggi University Hospital, Firenze 5 Hematology Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia 6 Hematology, Azienda Ospedaliero Universitaria città della Salute e della Scienza di Torino 7 Radiation Oncology Department, Radiation Oncology,University of Turin, Torino, Italy
Introduction: The management of elderly patients remain a challenge for clinicians. Objectives: The aim of this multicentric retrospective analysis is to describe the patterns of disease and of care, prognostic impact of treatment regimen, comorbidities and toxicities in localized elderly DLBCL patients. Methods: We retrospectively analysed the data of elderly patients with limited staged DLBCL, treated between 2002 and 2012. Medical history was reviewed for patient characteristic, treatment and outcomes. All patients were assessed for the Charlson comorbidity-index (CCI) score, and age-adjusted International Prognostic Index (aaIPI). Progression free survival (PFS) and overall survival (OS) were estimated and compared between between patients who received R-CH alone versus R-CH plus IFRT. Results: Detailed treatment records were available for 64 patients. No statistically significant difference was observed between the 2 cohorts of patients in age, LDH level, extranodal disease, IPI score excluded stage and B symptoms.Median follow-up for all patients was 59.8 months. Of the 64 analysed patients, 27 were treated with R-CH and 37 with R-CH plus IFRT. The most common toxic effects were represented by haematological toxicity in both groups; G3-4 hematological toxicity was reported in 3 patients who received R-chemotherapy alone and in 4 irradiated patients. In general, IFRT was tolerated reasonably well with minor acute toxicity; only 4 patients showed G2 acute toxicity. Response assessment of all treatment regimens showed a complete remission (RC) in 42 (65%) patients; in the group treated with R-CH alone 89% of patients reached a RC. In the group of combined therapy, after CH, only 75% of patients showed a RC. The percentage of RC increased at 95% after IFRT. There is a trend for improved RC with the addition of consolidative RT to R-CH (p = 0.0518). 2 years OS in R-CH and R-CH plus IFRT patients were 96% and 100%, respectively, without any statistical difference between two groups (p = 0.969). Median PFS for R-CH group was 52.5 months compared to 54 months in patients treated with R-CH plus IFRT , and 2-years PFS was 94.2% and 95% , respectively. In the multivariate analysis, the aa-IPI score was significantly associated with PFS (p = 0.04). Conclusion: Results of the present study suggest that R-CH and R-CH plus IFRT may offer satisfactory disease control in elderly patients affected with stage I-II DLBCL. Response rate was slightly higher for RT. Biases in results evaluation are the widely variable
Abstracts
number of CT cycles and the use of RT either as consolidation after R-CT or as integral part of a combined modality program. However, data collection and analysis will be further expanded and the role of prognostic factors such as bulky disease, number of nodal stations involved as well as acute and late toxicity will be evaluated. Disclosure of Interest: None declared Keyword: Haematological doi:10.1016/j.jgo.2014.09.069
Myeloma in the elderly P040 POLYPHARMACY AND POTENTIALLY INAPPROPRIATE MEDICATION IN ELDERLY PATIENTS TREATED FOR MULTIPLE MYELOMA B. Beauplet1,⁎, A. Martin2, S. Klein1, O. Riquet1, R. Morello3, M. Macro4 1 Service de medecine geriatrique 8.36 2 Pharmacy 3 Biostatistique 4 Service d'hématologie, CHU, Caen cedex 9, France
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with male sexe (p = 0.037 bilateral, Chi2). There was no link between CCI and polymedication, nor age. Conclusion: High rate of polypharmacy, PIM and renal insufficiency in the elderly with multiple myeloma, requires combined pharmaceutical and geriatric assessments, with patients and general practitioners education, before introducing chemotherapy. That may leads to further adverse events. Both evaluation will be included in a daily oncogeriatric hospitalization. References: Ronald J. Maggiore, Cary P. Gross and Arti Hurria.Polypharmacy in Older Adults with Cancer The Oncologist 2010, 15:507–522.doi: 10.1634/theoncologist.2009-0290 originally published online April 24, 2010 Palumbo A, Mina R. Management of older adults with multiple myeloma. Blood Rev. 2013 May;27(3):133–42. doi: 10.1016/ j.blre.2013.04.001. Epub 2013 Apr 25. Review. Engelhardt M et al. European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma HAemtologica 2014 Feb; 99(2):232–42 Disclosure of Interest: None declared Keyword: Myeloma
Introduction: Potentially Inappropriate Medications (PIM) can increase adverse drug events incidence. Elderly patients are particularly at risk because of several comorbidities requiring pharmacotherapy. The prevalence of polypharmacy in older adults ranges from 13% to 92%, depending on the polypharmacy definition and on the study population characteristics. Cancer related therapy adds to this risk in older adults, but few studies have been conducted in this population. In multiple myeloma, renal insufficiency is frequent and increase adverse events risk. In patients with therapeutic indication, the overall 5-year survival has increased significantly with new targeted therapies also in the elderly. When patients are ineligible for transplantation, the standard treatment is a combination therapy based with melphalan, corticosteroid plus bortezomib (VMP) or thalidomide (MPT). Toxicities are common (30-40% of cases in early treatment). Objectives: The aim of this study is to evaluate polypharmacy and PIM prevalences in elderly people treated for multiple myeloma. Methods: Retrospective study from January 1st to December 31st 2013 in the hematology unit of Caen University Hospital. Including consecutive patients ≥70 years for whom a treatment has been introduced for multiple myeloma (oral or parenteral treatment in daily hospitalization). Polypharmacy (≥5 daily different medications before introducing chemotherapy), PIM (Independent and Considering Diagnosis Medications to avoid in 2012 version Beers list), renal insufficiency, comorbidity (Charlson Comorbidity Index) were collected. Univariate analysis was performed with Anova test, correlation with Pearson, Spearman. Results: 96 patients were included: mean age was 77,7 years [70– 92], median age 76,5, with no difference inside sex subgroup, 34 were 80 years old and over, 48 female. Renal function was normal in only 12% of patients with MDRD formula, and 9% with Cockroft (missing data for 8 patients). 36% had serum albumin b30 g/l (10 missing data) 74% had polymedication whereas mean CCI was only 1,1 (62% had CCI ≤ 1) Mean PIM per patient was 1,17 with Beers list [0–6], only 37,5% had no PIM. Each patient had at least one of these fragility. Polymedication and number of PIM were significatively correlated (p b0.001 bilateral, Chi2). CCI ≥ 1 was significatively correlated
doi:10.1016/j.jgo.2014.09.070
Basic research P041 THREE COMPONENTS OF A GERIATRIC SCREENING DETERMINE THE GERIATRIC PROGNOSTIC INDEX (GPI) AS RISK PROFILE BEFORE CHEMOTHERAPY IN THE ELDERLY A. Aaldriks1, H. Nortier2 on behalf of E. Maartense, J.W.R. Nortier, L. van der Geest, S. le cessie, B.C. Tanis, J.E.A. Portielje, P. Ypma, E.J. Giltay 1 Department of Psychiatry, BoumanGGZ, Delft, Netherlands 2 Department of Clinical Oncology, Leiden University Medical Center, Leiden, Netherlands Introduction: Comprehensive geriatric assessment (CGA) is a multidimensional but time-consuming method to detect frailty in elderly patients with cancer. Therefore, a two-step approach (screening followed by a full CGA) may be more efficient. Further time saving might be accomplished by identifying the essential items of screening tool instruments that correctly classify the elderly patients at risk for toxicity and overall mortality. Objectives: The aim of this study was to construct a Geriatric Prognostic Index with individual items of a geriatric assessment who were independently predictive for toxicity and mortality. Methods: Patients older than 70 years of age with various types of cancer (n = 494) were assessed before the first scheduled chemotherapy administration. GA consisted of the Mini Nutritional Assessment (MNA), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Groningen Frailty Indicator (GFI) and Mini Mental State Examination (MMSE). Significant predictive individual items (p b 0.01) for toxicity and mortality were entered in the multivariable logistic regression and Cox-regression models, adjusted for gender, age, purpose of treatment, type of malignancy. Finally, a three-item sum scale was constructed and tested for mortality risk. Results: The 494 included cancer patients had a median age of 75 years (range 70–92 years), and 49.9% were men. The majority of
Abstracts
Conclusion: Elderly patients 70 years or older do not experience more delay in the fast-track cancer programme for H&N cancer at Odense University Hospital. The time to start of treatment for these patients was similar to patients less than 70 years of age and not influenced significantly by comorbidity and performance. Disclosure of interest: None declared. Keywords: Demography, Networks, Policies doi:10.1016/j.jgo.2014.09.066
Haematological cancer in elderly patients P038 DISRUPTION OF THE CLINICAL CARE PATHWAY IN GERIATRIC HEMATOLOGY: IMPACT OF THE GERIATRIC ASSESSMENT N. Signol1,⁎, A. Pham Dang2, J. B. Fargeas1, M. A. Picat3, A. Penot1, C. Vallejo2, T. Dantoine3, D. Bordessoule1 1 Clinical Hematology Department, France 2 Emergency Department 3 Geriatric Medicine Department, CHU Dupuytren, LIMOGES, France Introduction: A study conducted in a university hospital on the years 2005–2006 is interested in the emergency department (ED) access of patients with hematological malignancies (HM). Caring a population of mostly elderly patients, geriatric assessment (GA) was implemented in an clinical hematology department. Objectives: The objective of this work was to assess the impact of GA on disruptor of the care pathway manifested by emergency admissions. Methods: A retrospective analysis based on a sample of 183 patients visits to the ED during 2011 and 2012 and suffering of HM. A comparative analysis based on the age of patients has been established with a cut-off at 70 years. Comparisons were made on repeated ED visits, social and familial status, daily medications, comorbidities, realization of GA. Results: Among the 183 patients included during 2 years, 55,7 % were aged more than 70 years (n = 102/183). 71% (n = 72/102) of elderly patients have benefited from a GA. 51% make at least 2 admissions to emergencies (n = 52/102) and among these, 29% (n = 15/52) were socially isolated, 99% had at least one comorbidity (n = 100/102). 29% (n = 53/102) took more than 6 treatments per day. The hematologic malignancy diagnosis (HM) was known before the emergency admission to the majority of patients: 74.5% (n = 76/ 102). Although these results objectify a real improvement of EG compared to years 2005–2006, 1/3 of old patients with HM has not benefited from a GA. According to the latest French National Cancer Plan, the optimal care pathway in geriatric hematology must associate a customize plan of care, a GA , a social assessment , therapeutic education sessions to prevent and reduce situation of care disruption. Conclusion: Patients suffering of HM coming to the ED are mostly aged more than 70 years. Although the GA is an essential clinical and quality measure, it’s not sufficient to prevent disruption of clinical care pathway: specific hemato-geriatric network seem necessary. Reference: N. Signol et al. .Emergency access to elderly patients suffering from hematologic malignancies in an university hospital. Study based on 175 cases in Limousin, France. SIOG congres 2012. Disclosure of interest: None declared. Keywords: Haematological, Networks doi:10.1016/j.jgo.2014.09.068
Haematological cancer in elderly patients P039 A MULTICENTRIC RETROSPECTIVE ANALYSIS ON CLINICAL OUTCOMES FOR ELDERLY PATIENTS WITH STAGE I-II DIFFUSE LARGE B-CELL LYMPHOMA P. Ciammella1,⁎, A. R. Filippi2, M. Buglione3, G. Simontacchi4, A. Ruffini5, U. Vitolo6, F. Merli5, U. Ricardi7 1 Radiation Oncology Unit, Department of Advanced Technology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia 2 Department of Oncology, Radiation Oncology,University of Turin, Torino 3 Radiation Oncology Department, AO Spedali Civili-Istituto del Radio, università degli Studi di Brescia, Brescia 4 Radiotherapy Department, Careggi University Hospital, Firenze 5 Hematology Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia 6 Hematology, Azienda Ospedaliero Universitaria città della Salute e della Scienza di Torino 7 Radiation Oncology Department, Radiation Oncology,University of Turin, Torino, Italy
Introduction: The management of elderly patients remain a challenge for clinicians. Objectives: The aim of this multicentric retrospective analysis is to describe the patterns of disease and of care, prognostic impact of treatment regimen, comorbidities and toxicities in localized elderly DLBCL patients. Methods: We retrospectively analysed the data of elderly patients with limited staged DLBCL, treated between 2002 and 2012. Medical history was reviewed for patient characteristic, treatment and outcomes. All patients were assessed for the Charlson comorbidity-index (CCI) score, and age-adjusted International Prognostic Index (aaIPI). Progression free survival (PFS) and overall survival (OS) were estimated and compared between between patients who received R-CH alone versus R-CH plus IFRT. Results: Detailed treatment records were available for 64 patients. No statistically significant difference was observed between the 2 cohorts of patients in age, LDH level, extranodal disease, IPI score excluded stage and B symptoms.Median follow-up for all patients was 59.8 months. Of the 64 analysed patients, 27 were treated with R-CH and 37 with R-CH plus IFRT. The most common toxic effects were represented by haematological toxicity in both groups; G3-4 hematological toxicity was reported in 3 patients who received R-chemotherapy alone and in 4 irradiated patients. In general, IFRT was tolerated reasonably well with minor acute toxicity; only 4 patients showed G2 acute toxicity. Response assessment of all treatment regimens showed a complete remission (RC) in 42 (65%) patients; in the group treated with R-CH alone 89% of patients reached a RC. In the group of combined therapy, after CH, only 75% of patients showed a RC. The percentage of RC increased at 95% after IFRT. There is a trend for improved RC with the addition of consolidative RT to R-CH (p = 0.0518). 2 years OS in R-CH and R-CH plus IFRT patients were 96% and 100%, respectively, without any statistical difference between two groups (p = 0.969). Median PFS for R-CH group was 52.5 months compared to 54 months in patients treated with R-CH plus IFRT , and 2-years PFS was 94.2% and 95% , respectively. In the multivariate analysis, the aa-IPI score was significantly associated with PFS (p = 0.04). Conclusion: Results of the present study suggest that R-CH and R-CH plus IFRT may offer satisfactory disease control in elderly patients affected with stage I-II DLBCL. Response rate was slightly higher for RT. Biases in results evaluation are the widely variable
Abstracts
number of CT cycles and the use of RT either as consolidation after R-CT or as integral part of a combined modality program. However, data collection and analysis will be further expanded and the role of prognostic factors such as bulky disease, number of nodal stations involved as well as acute and late toxicity will be evaluated. Disclosure of Interest: None declared Keyword: Haematological doi:10.1016/j.jgo.2014.09.069
Myeloma in the elderly P040 POLYPHARMACY AND POTENTIALLY INAPPROPRIATE MEDICATION IN ELDERLY PATIENTS TREATED FOR MULTIPLE MYELOMA B. Beauplet1,⁎, A. Martin2, S. Klein1, O. Riquet1, R. Morello3, M. Macro4 1 Service de medecine geriatrique 8.36 2 Pharmacy 3 Biostatistique 4 Service d'hématologie, CHU, Caen cedex 9, France
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with male sexe (p = 0.037 bilateral, Chi2). There was no link between CCI and polymedication, nor age. Conclusion: High rate of polypharmacy, PIM and renal insufficiency in the elderly with multiple myeloma, requires combined pharmaceutical and geriatric assessments, with patients and general practitioners education, before introducing chemotherapy. That may leads to further adverse events. Both evaluation will be included in a daily oncogeriatric hospitalization. References: Ronald J. Maggiore, Cary P. Gross and Arti Hurria.Polypharmacy in Older Adults with Cancer The Oncologist 2010, 15:507–522.doi: 10.1634/theoncologist.2009-0290 originally published online April 24, 2010 Palumbo A, Mina R. Management of older adults with multiple myeloma. Blood Rev. 2013 May;27(3):133–42. doi: 10.1016/ j.blre.2013.04.001. Epub 2013 Apr 25. Review. Engelhardt M et al. European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma HAemtologica 2014 Feb; 99(2):232–42 Disclosure of Interest: None declared Keyword: Myeloma
Introduction: Potentially Inappropriate Medications (PIM) can increase adverse drug events incidence. Elderly patients are particularly at risk because of several comorbidities requiring pharmacotherapy. The prevalence of polypharmacy in older adults ranges from 13% to 92%, depending on the polypharmacy definition and on the study population characteristics. Cancer related therapy adds to this risk in older adults, but few studies have been conducted in this population. In multiple myeloma, renal insufficiency is frequent and increase adverse events risk. In patients with therapeutic indication, the overall 5-year survival has increased significantly with new targeted therapies also in the elderly. When patients are ineligible for transplantation, the standard treatment is a combination therapy based with melphalan, corticosteroid plus bortezomib (VMP) or thalidomide (MPT). Toxicities are common (30-40% of cases in early treatment). Objectives: The aim of this study is to evaluate polypharmacy and PIM prevalences in elderly people treated for multiple myeloma. Methods: Retrospective study from January 1st to December 31st 2013 in the hematology unit of Caen University Hospital. Including consecutive patients ≥70 years for whom a treatment has been introduced for multiple myeloma (oral or parenteral treatment in daily hospitalization). Polypharmacy (≥5 daily different medications before introducing chemotherapy), PIM (Independent and Considering Diagnosis Medications to avoid in 2012 version Beers list), renal insufficiency, comorbidity (Charlson Comorbidity Index) were collected. Univariate analysis was performed with Anova test, correlation with Pearson, Spearman. Results: 96 patients were included: mean age was 77,7 years [70– 92], median age 76,5, with no difference inside sex subgroup, 34 were 80 years old and over, 48 female. Renal function was normal in only 12% of patients with MDRD formula, and 9% with Cockroft (missing data for 8 patients). 36% had serum albumin b30 g/l (10 missing data) 74% had polymedication whereas mean CCI was only 1,1 (62% had CCI ≤ 1) Mean PIM per patient was 1,17 with Beers list [0–6], only 37,5% had no PIM. Each patient had at least one of these fragility. Polymedication and number of PIM were significatively correlated (p b0.001 bilateral, Chi2). CCI ≥ 1 was significatively correlated
doi:10.1016/j.jgo.2014.09.070
Basic research P041 THREE COMPONENTS OF A GERIATRIC SCREENING DETERMINE THE GERIATRIC PROGNOSTIC INDEX (GPI) AS RISK PROFILE BEFORE CHEMOTHERAPY IN THE ELDERLY A. Aaldriks1, H. Nortier2 on behalf of E. Maartense, J.W.R. Nortier, L. van der Geest, S. le cessie, B.C. Tanis, J.E.A. Portielje, P. Ypma, E.J. Giltay 1 Department of Psychiatry, BoumanGGZ, Delft, Netherlands 2 Department of Clinical Oncology, Leiden University Medical Center, Leiden, Netherlands Introduction: Comprehensive geriatric assessment (CGA) is a multidimensional but time-consuming method to detect frailty in elderly patients with cancer. Therefore, a two-step approach (screening followed by a full CGA) may be more efficient. Further time saving might be accomplished by identifying the essential items of screening tool instruments that correctly classify the elderly patients at risk for toxicity and overall mortality. Objectives: The aim of this study was to construct a Geriatric Prognostic Index with individual items of a geriatric assessment who were independently predictive for toxicity and mortality. Methods: Patients older than 70 years of age with various types of cancer (n = 494) were assessed before the first scheduled chemotherapy administration. GA consisted of the Mini Nutritional Assessment (MNA), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Groningen Frailty Indicator (GFI) and Mini Mental State Examination (MMSE). Significant predictive individual items (p b 0.01) for toxicity and mortality were entered in the multivariable logistic regression and Cox-regression models, adjusted for gender, age, purpose of treatment, type of malignancy. Finally, a three-item sum scale was constructed and tested for mortality risk. Results: The 494 included cancer patients had a median age of 75 years (range 70–92 years), and 49.9% were men. The majority of