Data from U.S. Lymphocare suggest that older patients with follicular lymphoma (FL) are more commonly treated with watchful waiting or single-agent rituximab and found no difference in outcomes by treatment groups, but comorbidity was not studied. Researchers aimed to describe patient features, comorbidity use of positron-emission tomography (PET) staging, management choices, and the impact of polypharmacy on outcomes of patients with FL aged 70 years or older. Prathima Reddy, MD, at CHI Franciscan Hospital in Federal Way, WA, discussed the findings at the ASH Annual Meeting.

“We specifically sought to address whether the Charlson Comorbidity Index (CCI) influences management choice or outcomes in this increasingly common subgroup of patients,” the researchers noted.

They identified 128 patients with FL aged 70 years or older who were seen at the University of Washington/Seattle Cancer Care Alliance between 2008 and 2016. CCI was calculated, excluding lymphoma, and patients were classified as low CCI (score of 0–1, n = 23, 41%) or high CCI (≥ 2, n = 11, 20%).

They collected information on clinical presentation (grade or stage), CCI, number of medications (prescription, herbal, and vitamin), and management details.

A total of 57 patients (median age = 76 years, range = 70–92) had adequate information and at least three months of follow-up from diagnosis and were analyzed in detail. Patients were followed for a median of 32 months. Most patients (n = 34, 61%) had a CCI score of > 1, and the median number of medications used was eight, including prescriptions, supplements, and vitamins. Twenty-six patients (46%) underwent baseline PET imaging. Seventeen patients were initially observed, and the other 40 received radiotherapy, rituximab, or chemotherapy plus rituximab.

The median time from diagnosis to initiation of therapy was five months, and the time to treatment was not affected by CCI > 1, use of PET in staging, or most clinical features. Time to treatment was affected by FL grade 3, the presence of more than 4 nodal sites, and a high-risk FL International Prognostic Index score.

The median progression-free survival (PFS) was more than five years, but continual relapses occurred with prolonged follow-up. PFS was unaffected by CCI > 1, polypharmacy, or clinical features.

Eight deaths occurred, three of which were because of lymphoma. Decreased overall survival was associated anemia (multivariate p = 0.007).

“Neither CCI > 1 nor presence of polypharmacy predicted time to initiation of therapy,” the researchers noted. “These data suggest that disease-related factors remain a prime consideration for managing [older patients with] FL in practice. Improved models for discriminating between comorbidities and tumor-related prognostic features for [older patients with] FL are needed to guide the management of this growing population.”

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