Impact of frailty in survival of older patients with classical Hodgkin lymphoma: A retrospective, multicenter study from the spanish registry of lymphoma (RELINF) of the spanish group of lymphoma (GELTAMO)

Abstract Introduction. The outcomes of older adults with classical Hodgkin Lymphoma (cHL) have improved in recent decades. However, despite having better treatment strategies and better supportive care, the prognosis remains poor for those aged ≥70 years. Frailty has been associated with poor outcomes and worse tolerance of treatments in older patients with hematological malignancies. Hence, there are recommendations to perform geriatric assessment (GA) and to integrate it into the treatment decision plan, but the implementation in clinical practice is still limited. Methods. We conducted a retrospective, multicenter study in the Spanish Lymphoma Registry (RELINF) of the Spanish Lymphoma Group (GELTAMO). Hereby, we enrolled in this study 673 patients with cHL aged 60 years or above from 46 Spanish centers. We analyzed the impact of comorbidities and frailty on their outcome. We collected baseline patient characteristics, including activities of daily living (ADL), instrumental activities of daily living (IADL), geriatric syndromes, and comorbidities scored with CIRS-G. Statistical analyses were done with R. Results. Median age at diagnosis was 72 years (range 60-93), 57.8% were male, 65.7% were diagnosed with advanced stage, and 43.9% with extranodal involvement. CIRS score was collected in 417 patients, with a median score of 4 (range 0-13). Activities of daily living (ADL) were collected in 569 patients, with 79 (13.9%) of them showing impairments. Instrumental activities of daily living (IADL) were collected in 532 patients, with impairments in 94 (17.7%) of them. Geriatric syndromes were detected in 84 patients (14.4%). In the univariate analyses, age >71 years (HR 1.08, 95%CI 1.06-1.10, p<0.001), previous history of cardiovascular disease (HR 1.79, 95%CI 1.35-2.39, p<0.001), extranodal involvement (HR 1.69, 95%CI 1.28-2.23, p<0.001), advanced stage (HR 4.99, 95%CI 2.18-11.4, p<0.001), ECOG >2 (HR 10.4, 95%CI 6.64-16.2, p<0.001), impairment in ADL (HR 3.78, 95%CI 2.66-5.36, p<0.001), and IADL (HR 3.75, 95%CI 2.65-5.30, p<0.001), presence of geriatric syndromes (HR 1.83, 95%CI 1.25-2.68, p=0.002), and cardiac (HR 1.85, 95%CI 1.28-22.65, p=0.001), and psychiatric (HR 1.80, 95%CI 1.21-2.67, p=0.004) comorbidities had a negative impact in the survival. In lab tests, only absolute lymphocyte counts (ALC), hemoglobin, albumin and ESR had impact in survival. With regard to treatments, no differences were seen among all therapies. Only palliative regimens showed shorter survival (HR 11.5, 95%CI 7.73-17.2, p<0.001). In the multivariate analysis, age, ECOG, anemia, geriatric syndromes and palliative therapy had an impact on OS. Conclusions. Functional reserve and resilience have an impact on the outcome of older patients with cHL. Frailty assessment through a GA should be incorporated in the evaluation of older patients with cHL to identify those patients at higher risk. Better and safer treatment strategies are needed to overcome the poorer prognosis of this group of patients.

Authors

Institutions

Publication Details

Journal
Blood
Published
2025-11-03
DOI
https://doi.org/10.1182/blood-2025-6264
Primary Topic
Lymphoma Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Impact of frailty in survival of older patients with classical Hodgkin lymphoma: A retrospective, multicenter study from the spanish registry of lymphoma (RELINF) of the spanish group of lymphoma (GELTAMO)

Eukene Gainza, Ignacio Mahíllo, Miriam Moreno, Cristina Barrenetxea et al.
Blood
Lymphoma Diagnosis and Treatment
article

Impact of frailty in survival of older patients with classical Hodgkin lymphoma: A retrospective, multicenter study from the spanish registry of lymphoma (RELINF) of the spanish group of lymphoma (GELTAMO)

Eukene Gainza, Ignacio Mahíllo, Miriam Moreno, Cristina Barrenetxea, Antonio M. Gutierrez, María García Roa, Paola Villafuerte Gutiérrez, María Isabel Gómez Roncero, Eva Domingo‐Doménech, Tamara Torrado, Mariana Bastos‐Oreiro, Alfonso Bouzas Ortíz, Teresa Cobo, Isabel González-Gascón-y-Marín, Cecilia Carpio, Norma Carmen Gutierrez, Mario Arnao, Joan Buch, J. Núñez, Elena Rámila, Maria Luisa Bengochea, Carmen Alonso Prieto, Belén Navarro Matilla, S. Ferrero, Paula Fernández‐Caldas, María Jesús Peñarrubia, Izaskun Zeberio, N. Dominguez, Blanca Sánchez‐González, Raúl Córdoba, Hugo Luzardo, Ramón Dı́az-Trelles, Samuel Romero Domínguez, Haridian de la Nuez, Maria Carmen Martinez Munoz, Juan Carlos Caballero, Jimena Cannata, Laurentino Benito, I Eizaguirre, Emilia Pardal De La Mano, Luis Ignacio Sancho Val, M. Luz Maestre, Richard Alonso, Liliana del Rosario Maceo Gómez, Beatriz De La Cruz, Eva Donato, M. Mora, David Alonso Castronuño, Begona Mendibil, Sofia Martin-Consuegra
article en

Abstract

Abstract Introduction. The outcomes of older adults with classical Hodgkin Lymphoma (cHL) have improved in recent decades. However, despite having better treatment strategies and better supportive care, the prognosis remains poor for those aged ≥70 years. Frailty has been associated with poor outcomes and worse tolerance of treatments in older patients with hematological malignancies. Hence, there are recommendations to perform geriatric assessment (GA) and to integrate it into the treatment decision plan, but the implementation in clinical practice is still limited. Methods. We conducted a retrospective, multicenter study in the Spanish Lymphoma Registry (RELINF) of the Spanish Lymphoma Group (GELTAMO). Hereby, we enrolled in this study 673 patients with cHL aged 60 years or above from 46 Spanish centers. We analyzed the impact of comorbidities and frailty on their outcome. We collected baseline patient characteristics, including activities of daily living (ADL), instrumental activities of daily living (IADL), geriatric syndromes, and comorbidities scored with CIRS-G. Statistical analyses were done with R. Results. Median age at diagnosis was 72 years (range 60-93), 57.8% were male, 65.7% were diagnosed with advanced stage, and 43.9% with extranodal involvement. CIRS score was collected in 417 patients, with a median score of 4 (range 0-13). Activities of daily living (ADL) were collected in 569 patients, with 79 (13.9%) of them showing impairments. Instrumental activities of daily living (IADL) were collected in 532 patients, with impairments in 94 (17.7%) of them. Geriatric syndromes were detected in 84 patients (14.4%). In the univariate analyses, age >71 years (HR 1.08, 95%CI 1.06-1.10, p<0.001), previous history of cardiovascular disease (HR 1.79, 95%CI 1.35-2.39, p<0.001), extranodal involvement (HR 1.69, 95%CI 1.28-2.23, p<0.001), advanced stage (HR 4.99, 95%CI 2.18-11.4, p<0.001), ECOG >2 (HR 10.4, 95%CI 6.64-16.2, p<0.001), impairment in ADL (HR 3.78, 95%CI 2.66-5.36, p<0.001), and IADL (HR 3.75, 95%CI 2.65-5.30, p<0.001), presence of geriatric syndromes (HR 1.83, 95%CI 1.25-2.68, p=0.002), and cardiac (HR 1.85, 95%CI 1.28-22.65, p=0.001), and psychiatric (HR 1.80, 95%CI 1.21-2.67, p=0.004) comorbidities had a negative impact in the survival. In lab tests, only absolute lymphocyte counts (ALC), hemoglobin, albumin and ESR had impact in survival. With regard to treatments, no differences were seen among all therapies. Only palliative regimens showed shorter survival (HR 11.5, 95%CI 7.73-17.2, p<0.001). In the multivariate analysis, age, ECOG, anemia, geriatric syndromes and palliative therapy had an impact on OS. Conclusions. Functional reserve and resilience have an impact on the outcome of older patients with cHL. Frailty assessment through a GA should be incorporated in the evaluation of older patients with cHL to identify those patients at higher risk. Better and safer treatment strategies are needed to overcome the poorer prognosis of this group of patients.

BloodVol. 146(Supplement 1)
Universidad de Salamanca (ES), Hospital Universitario La Paz (ES), University Hospital Complex Of Vigo (ES), Hospital General Universitario Gregorio Marañón (ES), Hospital Universitario Virgen Macarena (ES), Hospital General Universitario Morales Meseguer (ES), Althaia (ES), Hospital de Basurto (ES), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Complejo Hospitalario de Salamanca (ES), Marqués de Valdecilla University Hospital (ES), Biogipuzkoa Health Research Institute (ES), Hospital Universitario Fundación Alcorcón (ES), Hospital Royo Villanova (ES), Vall d'Hebron Institut de Recerca (ES), Hospital Universitario de Getafe (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Hospital Universitario Príncipe de Asturias (ES), Spanish Clinical Research Network (ES), Fundació CTM Centre Tecnològic (ES), Hospital Virgen de la Salud (ES), Hospital Clínic de Barcelona (ES), Hospital de Galdakao (ES), Hospital Arnau de Vilanova (ES), Hospital de Manises (ES), Hospital de Sabadell (ES), Hospital Universitario Doctor Peset (ES), Hospital Universitario del Sureste (ES), Vall d'Hebron Hospital Universitari (ES), Hospital Universitario Fundación Jiménez Díaz (ES), Hospital Universitario de La Princesa (ES), Hospital Del Mar (ES), Clinica Universidad de Navarra (ES), Hospital Clínico Universitario Lozano Blesa (ES), Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (ES), Hospital Universitario HM Sanchinarro (ES), Donostiako Unibertsitate Ospitalea (ES), Complexo Hospitalario Universitario A Coruña (ES), Duran i Reynals Hospital (ES), Hospital Universitario Lucus Augusti (ES), Santa Lucía University General Hospital (ES), Hospital Universitario Son Espases (ES), Hospital Universitari Germans Trias i Pujol (ES), Hospital Universitari de Girona Doctor Josep Trueta (ES), Hospital Clínico Universitario de Valladolid (ES), Hospital Universitario Severo Ochoa (ES), Hospital Virgen del Puerto (ES), Hospital Universitario Infanta Leonor (ES), Universidad de Navarra (ES)
Openalex Percentile: Top 47%
Lymphoma Diagnosis and Treatment
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.