Comprehensive Geriatric Assessment and Clinical Outcomes of Frail Older Adults with Diffuse Large B-cell Lymphoma: a Metanalysis

Introduction. Comprehensive geriatric assessment (CGA) is used to personalize cancer treatments in frail older adults. However, its utility to guide treatments in frail older patients with diffuse large B-cell lymphoma (DLBCL) is not well known. We performed a meta-analysis of evidence published in this area. Material and methods. We searched PubMed and Google Scholar for studies published between January 2000 and January 2023 that included patients aged ≥ 65 years with a diagnosis of DLBCL who underwent CGA before treatment (CGA-modulated studies) and who did not (non-CGA-modulated studies). We evaluated clinical outcomes in frail/unfit patients in terms of complete response (CR), incidence of grade ≥ 3 toxicity, and 2-year overall survival (OS) in both types of studies. Results. Fifteen studies [8 CGA-modulated (n = 733, median age 76, 54% male, 52% frail/unfit) and 7 non-CGA-modulated (n = 2447, median age 76, 52% male, 32% frail/unfit)] were included. In the CGA-modulated studies, the CR proportion of frail/unfit patients was 34% (95% CI 23–46%) vs . 28% (95% CI 19–38%) in the non-CGA-modulated studies (p = 0.436). Grade 3–4 hematological toxicity in frail/unfit patients was 26% (95% CI 5–55%) vs . 36% (95% CI 13–63%) (p = 0.583), respectively. Two-year OS of frail/unfit patients was 52% (95% CI 38–66%) vs . 27% (95% CI 19–36%) (p = 0.003), respectively. Conclusions. Although the proportion of frail/unfit patients was lower in non-CGA-modulated studies, CGA-modulated studies reported higher OS. CGA could be useful to guide the treatment plan in older patients with DLBCL. Randomized clinical trials with standardized CGA instruments are necessary to confirm these findings.