Treatment Outcomes in Elderly Patients Receiving First Line Therapy for Diffuse Large B-Cell Lymphoma
In this video, Diana Abbott, PhD, and Grace Bosma, MS, discuss their team’s study on the outcomes and intensity of first-line therapy for the treatment of diffuse large B-cell lymphoma (DLBCL) in elderly patients. The findings of this study were presented at the American Society of Hematology (ASH) Annual Meeting & Exposition in San Diego, California.
Additional Resource:
Bair SM, Narkhede M, Frosh ZAK, et al. Treatment Intensity and Outcomes in Elderly Patients with DLBCL Receiving First Line Therapy. Paper presented at: American Society of Hematology's Annual Meeting & Exposition; December 9-12, 2023. Accessed December 13, 2023. https://ash.confex.com/ash/2023/webprogram/Paper187113.html
For additional information on ASH, visit: https://www.hematology.org/meetings/annual-meeting
For more coverage on ASH 2023, visit the newsroom.
TRANSCRIPTION:
Diana Abbott, PhD: My name is Dr. Diana Abbott. I am a PhD statistician who works with the Department of Hematology at the University of Colorado, and my colleague is
Grace Bosma, MS: Grace Bosma. I'm a master's level statistician also at University of Colorado.
Dr Abbott: So Grace and I were really excited to be pulled in on helping Dr. Bair with planning this study. And we're not the clinician, so I just want to give that caveat here. But an overview of the study basically with DLBCL, the standard of care, when you think about all of the population of patients may change when you look at older patients because we know that there are comorbidities, maybe different risk factors. And so this study wanted to hone in on older patients with DLBCL and see how they've been treated and whether their age makes a difference. Also, we looked at elderly patients and even further divided them into the younger group of the elderly patients, which is 70 to 79 years old, and then looked at patients that were older than 80 years old to see if those comorbidities or other factors had an effect on how they were treated and their survival outcomes based on how they were treated. So we looked at standard R-CHOP regimens, whether or not those regimens were reduced in intensity, and then if there were non anthracycline regimens that were used, and that is what we looked at.
Grace Bosma: Yeah, this paper was very interesting for several reasons, but I think the big thing that sets this paper apart from others is that papers that generally look into data like this don't have a lot of comorbidity information recorded. The people on this study did a very intensive manual review of comorbidities that typically aren't captured at diagnoses or in physician's day-to-day lives. So being able to look into that type of information and those comorbidities has been super interesting and super valuable in terms of looking at the outcomes of this paper.
Dr Abbott: We probably should give a shout out to Flatiron [Health electronic record] for use of their data as well. They have a really intense process of being able to apply to use their data and submitting protocols. And so it was a study that used the Flatiron data set. And so it was unique too because of the large sample size that we were able to obtain for this study.
I think the results of this study will help clinicians consider what's the best plan to have for treating elderly patients with DLBCL. It wasn't really investigated much prior to this study, or at least not in this large-scale way. Also, one benefit of this study is that it really reflects real-world data. The Flatiron dataset has about 80% of its data is coming from community clinics as opposed to the 20% from academic institutions. A lot of times, studies maybe are geared more toward academic institutions. So this study really shows what the real-world effect is of treating these patients. And the studies indicate some actions, which I think we'll get to later in the question, some action items for maybe how we can treat patients who are 70 to 79 years old or patients who are 80 or above. The implications of the study also indicate that we really need to understand what the comorbidities and other risk factors are for this patient population so that we can treat them with the right regimen.
Dr Abbott: Do you want to do that one, grace?
Grace Bosma: Yeah, sure. I think with most studies this study, the next step for this particular study would be reproducibility at other sites. Obviously, we are very proud of the work that we've done with the Flatiron data and with our research team, but we would love to see if other sites, if other universities, if other research teams are able to replicate the things that we were able to explore in our paper.
Dr Abbott: So I think the overall take-home message is that we need to have a better understanding of the full picture of the patients being treated, those who have DLBCL. So age is definitely a factor. We also need to understand their comorbidities better to treat them properly. This study, the conclusion, say for the 70- to 79-year-old age group, giving the standard R-CHOP regimen to everyone is suggested. Overall survival is better for those who receive standard R-CHOP and don't have reduced intensity. And it seems like with that age group that the patients are responding well to that standard dose and it's not introducing some effects that may be negatively impacting their survival. For the over-80 age group, it's suggesting that you have similar outcomes whether you reduce the intensity of the treatment or not. And so I think it's suggesting that comorbidities may be playing a bigger role in that age group. And so it's kind of a more complicated picture. We really need to understand the patient and what they're dealing with simultaneous to being treated for their disease.
I think another take-home message is that we need to maybe consider, so for this data set, for example, we didn't have full information on everything. We know that different genetic mutations may have an effect in the treatment that's received as well. And we didn't have all of that data. And so there were some things that we wish we could have put into our analysis and we didn't have that. And so I think another take-home message is we need to make sure that we are getting the full picture and understanding for each patient what it is that may make them respond or not respond well to treatment. We know that there's a trade off between toxicity and how effective the treatment is as well, and so we just need to have a better picture for each patient so that they can have good outcomes.
Grace Bosma: I think the future, or we hope that our paper helps contribute to a more nuanced approach to treatment for these patients, depending on age and comorbidities. Obviously, there's a lot that goes into giving patients the treatment that they need, but we hope that our paper is helpful in getting patients the most effective treatment that is the best fit for them.
Dr Abbott: Thank you for taking the time to listen to our summary of this study, and if you want to get more information about this, I believe that Dr. Bair's ASH presentation should be available with a video of his oral presentation. Also, there will be a paper coming out that publishes all of these findings and lots of beautiful graphs that he's made and contributed, and we just look forward to sharing all that we've worked on with you the public. So look for that in the future.