Contributions
Abstract: EP514
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Infection-related morbidity and mortality are increased in elderly patients (pts) treated for DLBCL compared to population-matched controls. Key predictive factors for infection-related hospitalisation during R-CHOP and infective deaths in elderly pts during and following R-CHOP remain incompletely understood.
Aims
We aimed to examine the influence of baseline characteristics, presentation, comorbidities, and intended dose intensity (IDI; combined % dose: cyclophosphamide & doxorubicin at cycle 1) in a 690 consecutive elderly (≥70 years (ys)) DLBCL pts on the risk of both infection-related morbidity (i.e. single &/or multiple infective admissions), & infection-related mortality occurring on or following therapy
Methods
Pts receiving full or mini R-CHOP were analysed for risk of infection-related admission & infection-related death. Factors potentially related to such endpoints were analysed by standard & ordinal logistic regression.
Results
Median age was 77 ys. 34.4% were ≥80 ys. Median follow-up was 2.8 ys. Pt and baseline disease characteristics were assessed in addition to IDI. 17% received primary quinolone prophylaxis. 72% of pts were not hospitalised with infection. Across all ages, the mean rate per R-CHOP cycle of an admission due to neutropenic infection was 7.9% in those with an IDI ≥80% compared to 3.3% in those with an IDI <80% (rank-sum p<0.0001). Increased risk of infection-related admission was independently associated with IDI >80% across all pts. In 331 pts receiving an IDI ≥80%, 33% were hospitalised with ≥1 infection compared to 23.3% of 355 pts receiving IDI <80% (univariable OR:1.61 (95% CI 1.14-2.26), p=0.006; multivariable OR: 2.12 (1.38-3.25), p=0.001. Antibiotic prophylaxis was associated with lower risk of infection (univariable OR: 0.37 (0.22-0.64), p<0.001, multivariable OR: 0.29 (0.16-0.51), p<0.001). In those ≥80 ys, risk of ≥1 infection-related admission was 32.4% (11/34) in those with an IDI >80% versus 21.3% (43/202) in those with an IDI <80% (OR:1.77, 95% CI 0.80-3.91, p=0.16). In this same group ≥80 ys, mean rate of admission per cycle specifically with neutropenic fever was numerically higher at 7.4% for those with an IDI ≥80% versus 2.9% with an IDI <80% (rank-sum p=0.06). 51 pts (7.4%) died due to infection. 6-month, 12-month, 2-yr and 5-yr cumulative incidence of infection-related death was 3.3%, 5.0%, 7.2% and 11.1% respectively. Key independent factors associated with infection-related death were: IPI 3-5, CIRS-G ≥6 and low albumin; enabling production of a predictive risk score. CIRS-G ≥6 were assigned 2 points, IPI 3-5 were assigned 1 point and baseline albumin ≤36 were assigned 1 point. 3 distinct cohorts were defined. Risk groups included 106 pts (15.5%, score 0), 316 pts (46.4%, score 1-2) and 259 pts (38.0%, score 3-4) respectively. 2-yr cumulative incidence of infective mortality with a score of 0 was 0%, score 1-2 was 3.6% (95% CI 1.8%>6.9%) & score of 3-4 15.2% (95% CI 10.8%>21.1%). 5-yr cumulative incidence of infective mortality: score of 0 was 0%, score 1-2 was 8.3% (95% CI 4.3%>15.8%) & score 3-4 was 20.8% (95% CI 14.0%>30.3%) respectively.
Conclusion
Increased risk of infection-related admission is independently associated with R-CHOP IDI>80% and no antibiotic prophylaxis in elderly DLBCL pts. Independent factors associated with infection-related death were IPI 3-5, CIRS-G ≥6 & low albumin, enabling a predictive risk score. Whether high risk pts could be targeted with enhanced anti-microbial prophylaxis remains unknown and requires a randomised trial.
Keyword(s):
Abstract: EP514
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Infection-related morbidity and mortality are increased in elderly patients (pts) treated for DLBCL compared to population-matched controls. Key predictive factors for infection-related hospitalisation during R-CHOP and infective deaths in elderly pts during and following R-CHOP remain incompletely understood.
Aims
We aimed to examine the influence of baseline characteristics, presentation, comorbidities, and intended dose intensity (IDI; combined % dose: cyclophosphamide & doxorubicin at cycle 1) in a 690 consecutive elderly (≥70 years (ys)) DLBCL pts on the risk of both infection-related morbidity (i.e. single &/or multiple infective admissions), & infection-related mortality occurring on or following therapy
Methods
Pts receiving full or mini R-CHOP were analysed for risk of infection-related admission & infection-related death. Factors potentially related to such endpoints were analysed by standard & ordinal logistic regression.
Results
Median age was 77 ys. 34.4% were ≥80 ys. Median follow-up was 2.8 ys. Pt and baseline disease characteristics were assessed in addition to IDI. 17% received primary quinolone prophylaxis. 72% of pts were not hospitalised with infection. Across all ages, the mean rate per R-CHOP cycle of an admission due to neutropenic infection was 7.9% in those with an IDI ≥80% compared to 3.3% in those with an IDI <80% (rank-sum p<0.0001). Increased risk of infection-related admission was independently associated with IDI >80% across all pts. In 331 pts receiving an IDI ≥80%, 33% were hospitalised with ≥1 infection compared to 23.3% of 355 pts receiving IDI <80% (univariable OR:1.61 (95% CI 1.14-2.26), p=0.006; multivariable OR: 2.12 (1.38-3.25), p=0.001. Antibiotic prophylaxis was associated with lower risk of infection (univariable OR: 0.37 (0.22-0.64), p<0.001, multivariable OR: 0.29 (0.16-0.51), p<0.001). In those ≥80 ys, risk of ≥1 infection-related admission was 32.4% (11/34) in those with an IDI >80% versus 21.3% (43/202) in those with an IDI <80% (OR:1.77, 95% CI 0.80-3.91, p=0.16). In this same group ≥80 ys, mean rate of admission per cycle specifically with neutropenic fever was numerically higher at 7.4% for those with an IDI ≥80% versus 2.9% with an IDI <80% (rank-sum p=0.06). 51 pts (7.4%) died due to infection. 6-month, 12-month, 2-yr and 5-yr cumulative incidence of infection-related death was 3.3%, 5.0%, 7.2% and 11.1% respectively. Key independent factors associated with infection-related death were: IPI 3-5, CIRS-G ≥6 and low albumin; enabling production of a predictive risk score. CIRS-G ≥6 were assigned 2 points, IPI 3-5 were assigned 1 point and baseline albumin ≤36 were assigned 1 point. 3 distinct cohorts were defined. Risk groups included 106 pts (15.5%, score 0), 316 pts (46.4%, score 1-2) and 259 pts (38.0%, score 3-4) respectively. 2-yr cumulative incidence of infective mortality with a score of 0 was 0%, score 1-2 was 3.6% (95% CI 1.8%>6.9%) & score of 3-4 15.2% (95% CI 10.8%>21.1%). 5-yr cumulative incidence of infective mortality: score of 0 was 0%, score 1-2 was 8.3% (95% CI 4.3%>15.8%) & score 3-4 was 20.8% (95% CI 14.0%>30.3%) respectively.
Conclusion
Increased risk of infection-related admission is independently associated with R-CHOP IDI>80% and no antibiotic prophylaxis in elderly DLBCL pts. Independent factors associated with infection-related death were IPI 3-5, CIRS-G ≥6 & low albumin, enabling a predictive risk score. Whether high risk pts could be targeted with enhanced anti-microbial prophylaxis remains unknown and requires a randomised trial.
Keyword(s):