Longitudinal Patient-Reported Outcomes in Older Adults With Aggressive Lymphomas Receiving Chemoimmunotherapy
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".