Advanced

Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B-cell lymphoma : a Swedish lymphoma register study

Wästerlid, T. LU ; Mohammadi, M.; Smedby, K. E.; Glimelius, I.; Jerkeman, M. LU ; Bottai, M. and Eloranta, S. (2018) In Journal of Internal Medicine
Abstract

Background: Comorbidity impacts overall survival amongst patients with diffuse large B-cell lymphoma (DLBCL). However, associations of comorbidity with lymphoma characteristics, treatment selection and lymphoma-specific mortality are less well known. Objective: To examine the impact of comorbidity on DLBCL characteristics, treatment intent and cause of death. Methods: We identified 3905 adult patients diagnosed with DLBCL 2007–2013 through the Swedish Lymphoma Register. We assessed comorbid disease history according to the Charlson comorbidity index (CCI). Comorbidity data and causes of death were collected through register linkage. Associations were estimated using multinomial regression and flexible parametric survival models.... (More)

Background: Comorbidity impacts overall survival amongst patients with diffuse large B-cell lymphoma (DLBCL). However, associations of comorbidity with lymphoma characteristics, treatment selection and lymphoma-specific mortality are less well known. Objective: To examine the impact of comorbidity on DLBCL characteristics, treatment intent and cause of death. Methods: We identified 3905 adult patients diagnosed with DLBCL 2007–2013 through the Swedish Lymphoma Register. We assessed comorbid disease history according to the Charlson comorbidity index (CCI). Comorbidity data and causes of death were collected through register linkage. Associations were estimated using multinomial regression and flexible parametric survival models. Results: Overall, 45% of the patients (n = 1737) had a history of at least one comorbidity at DLBCL diagnosis (cardiovascular disease, diabetes and solid cancer were most frequent), and 997 (26%) had a CCI score of ≥2. The relative probability of presenting with poor performance status (PS > 2) was higher amongst comorbid patients [Relative Risk Ratio (RRR)PS
>2: 2.02, 95% CI: 1.63–2.51]. Comorbid patients had a substantially lower relative probability of receiving curative treatment (RRR: 0.48, 95% CI: 0.38–0.61). Amongst all patients, CCI ≥ 1 was associated with a significantly increased risk of all-cause and lymphoma-specific death after adjustments. Amongst patients selected for curative treatment, comorbidity was associated with an increased risk of all-cause death (HRCCI
>1: 1.54, 95% CI: 1.32–1.80), but not with lymphoma-specific death (HRCCI
>1: 1.05, 95% CI: 0.86–1.28). Conclusion: Comorbidity is associated with inferior DLBCL outcome, mainly due to a lower likelihood of receiving treatment with curative intent. Possibly, more comorbid DLBCL patients could be treated with curative intent if comorbid conditions were optimized in parallel.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
comorbidity, diffuse large B-cell lymphoma, prognosis, treatment
in
Journal of Internal Medicine
publisher
Wiley-Blackwell Publishing Ltd
external identifiers
  • scopus:85056194591
ISSN
0954-6820
DOI
10.1111/joim.12849
language
English
LU publication?
yes
id
0fd12af7-7068-42ff-bd93-0d22b99b7d0a
date added to LUP
2018-11-23 13:16:34
date last changed
2019-02-24 04:55:14
@article{0fd12af7-7068-42ff-bd93-0d22b99b7d0a,
  abstract     = {<p>Background: Comorbidity impacts overall survival amongst patients with diffuse large B-cell lymphoma (DLBCL). However, associations of comorbidity with lymphoma characteristics, treatment selection and lymphoma-specific mortality are less well known. Objective: To examine the impact of comorbidity on DLBCL characteristics, treatment intent and cause of death. Methods: We identified 3905 adult patients diagnosed with DLBCL 2007–2013 through the Swedish Lymphoma Register. We assessed comorbid disease history according to the Charlson comorbidity index (CCI). Comorbidity data and causes of death were collected through register linkage. Associations were estimated using multinomial regression and flexible parametric survival models. Results: Overall, 45% of the patients (n = 1737) had a history of at least one comorbidity at DLBCL diagnosis (cardiovascular disease, diabetes and solid cancer were most frequent), and 997 (26%) had a CCI score of ≥2. The relative probability of presenting with poor performance status (PS &gt; 2) was higher amongst comorbid patients [Relative Risk Ratio (RRR)<sub>PS</sub><br>
                            <sub>&gt;2</sub>: 2.02, 95% CI: 1.63–2.51]. Comorbid patients had a substantially lower relative probability of receiving curative treatment (RRR: 0.48, 95% CI: 0.38–0.61). Amongst all patients, CCI ≥ 1 was associated with a significantly increased risk of all-cause and lymphoma-specific death after adjustments. Amongst patients selected for curative treatment, comorbidity was associated with an increased risk of all-cause death (HR<sub>CCI</sub><br>
                            <sub>&gt;1</sub>: 1.54, 95% CI: 1.32–1.80), but not with lymphoma-specific death (HR<sub>CCI</sub><br>
                            <sub>&gt;1</sub>: 1.05, 95% CI: 0.86–1.28). Conclusion: Comorbidity is associated with inferior DLBCL outcome, mainly due to a lower likelihood of receiving treatment with curative intent. Possibly, more comorbid DLBCL patients could be treated with curative intent if comorbid conditions were optimized in parallel.</p>},
  author       = {Wästerlid, T. and Mohammadi, M. and Smedby, K. E. and Glimelius, I. and Jerkeman, M. and Bottai, M. and Eloranta, S.},
  issn         = {0954-6820},
  keyword      = {comorbidity,diffuse large B-cell lymphoma,prognosis,treatment},
  language     = {eng},
  month        = {10},
  publisher    = {Wiley-Blackwell Publishing Ltd},
  series       = {Journal of Internal Medicine},
  title        = {Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B-cell lymphoma : a Swedish lymphoma register study},
  url          = {http://dx.doi.org/10.1111/joim.12849},
  year         = {2018},
}