Page 141 - Haematologica May 2022

Prephase therapy in older patients with DLBCL
ures and CK levels with survival, some of these measures may warrant additional investigation in larger cohorts of patients.
Since the NHL-02 trial, prephase therapy with vin- cristine and prednisone has since been adopted in several trials.7-9 It has been speculated that prephase therapy
improves performance status thus reducing early cycle toxic death and allowing full-intensity chemoim- munotherapy as illustrated in the LYSA phase II trial.9 A recent prospective study also supported this notion by demonstrating an improved KPS and reduced incidence of febrile neutropenia with prephase therapy.22 However, the
Table 3. Impact of prephase therapy on geriatric assessment measures and proinflammatory cytokines.
Pre- to post-prephase therapy changes
Measures N
Changes (median, IQR)
P-value q-value 0.317 0.571
0.039 0.198 0.420 0.621 0.483 0.621 0.637 0.717 0.978 0.978 0.105 0.304
0.044 0.198 0.135 0.304
0.208 0.416 0.010 0.033 0.306 0.439 0.514 0.643 0.953 0.953 0.890 0.953 0.016 0.04 0.002 0.01 0.307 0.439 0.001 0.01
LDH (log level) Clinician rated KPS Patient rated KPS ADL
IADL
Activity limitation
TUG
CARG score
% risk
Cytokines (log level)
IFN-g IL-10 IL-12 IL-13 IL1-β IL-2 IL-4 IL-6 IL-8 TNF-a
30 0.01 (-0.24, 0.18) 32 0 (0, 10)
32 0 (0, 10)
31 0 (-10, 7.5) 31 0 (-0.5, 0)
31 0 (-12.5, 3.1)
29 -1 (-2, 1.01)
32 0 (-2, 0)
32 0 (-4, 0)
N Changes (median, IQR) 30 -0.06 (-1.61, 0.85)
30 -0.5 (-1.59, 0.2) 30 -0.09 (-0.38, 0.27) 30 0 (-1.19, 1.95) 30 0 (0, 1.19)
29 0.19 (-0.39, 1.68) 30 -0.25 (-0.84, 0.16) 30 -0.61 (-1.49, 0.05) 28 -0.33 (-0.91, 0.76) 30 -0.65 (-1.49, -0.03)
IQR: interquartile range; LDH: lactate dehydrogenase; KPS: Karnofsky performance scale; ADL: activities up and go; CARG: cancer and aging research group; IFN: interferon; IL: interleukin; TNF: tumor necrosis
of daily living; IADL: instrumental activities of daily living; TUG: timed-get- factor..
Table 4. Association of baseline and changes in geriatric assessment measures with toxicity events.
Characteristic (IQR)
Baseline LOG LDH Baseline cKPS
Baseline pKPS
Baseline ADL
Baseline IADL
Baseline ACTIVITY LIMIT Baseline TUG
Baseline CARG score Baseline % risk ΔinLOGLDH ΔincKPS
ΔinpKPS
ΔinADL
Δ in IADL
Δ in ACTIVITY LIMIT ΔinTUG
Δ in CARG score Δin%risk
N At least 1 toxic event, N = 22
33 5.60 (5.51, 5.96) 33 75 (70, 90)
33 80 (62, 98)
33 48 (26, 84)
33 13.00 (9.50, 14.00) 33 47 (44, 56)
31 11 (10, 20)
33 10.50 (9.00, 13.00)
33 66 (54, 89)
30 0.01 (-0.17, 0.17)
32 0(0,10) 0(0,15) 32 0(0,10) 0(0,5) 31 5(-5,10) 0(-10,0)
No toxic events, N = 11
5.40 (5.31, 5.89) 90 (70, 90)
90 (80, 90)
80 (32, 92) 14.00 (9.00, 14.00) 56 (38, 62)
P-value q-value 0.14 0.5
0.2 0.5 0.3 0.5 0.13 0.5 0.2 0.5 0.2 0.5 0.2 0.5 0.040 0.4 0.019 0.3 0.2 0.5 0.3 0.5 0.6 0.7 0.8 0.9 0.3 0.5 0.5 0.7 0.7 0.8 0.8 0.9
11 (9, 13) 9.00 (7.00, 10.50) 54 (52, 54) -0.20 (-0.26, 0.17)
31 0.00 (-1.00, 0.00)
31 0 (-14, 6)
29 -1.1 (-4.2, 1.1)
32 0.00 (-3.00, 0.00)
0.00 (0.00, 0.00) 0 (-12, 0) -0.3 (-1.4, 0.8) 0.00 (-1.00, 0.50)
32 0(-12,0) 0(0,0) >0.9 >0.9
IQR: interquartile range; LDH: lactate dehydrogenase; cKPS: clinician-rated karnofsky performance scale; pKPS: patient-rated Karnofsky performance scale; ADL: activities of daily living; IADL: instrumental activities of daily living; TUG: timed-get-up and go; CARG: cancer and aging group.
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