Functional, Nutritional, and Social Status Predict Survival Outcomes in Older Patients with CLL

Geriatric domains of functional status, social activity, and nutritional status were associated with overall survival (OS) and progression-free survival (PFS) in older adults with chronic lymphocytic leukemia (CLL), according to results from an analysis presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. The study was conducted by Julia Rice, BA, clinical research coordinator at Harvard Medical School, and colleagues.

Although CLL commonly affects older patients, few studies have examined the relationship between baseline geriatric assessments and clinical outcomes in this population, Ms. Rice and coauthors noted. With this analysis, the investigators reviewed data from 369 patients with CLL ages 65 and older who were enrolled in a phase III trial evaluating bendamustine plus rituximab, ibrutinib plus rituximab, or ibrutinib alone.

Most patients were male (67.1%), with a median age of 71 years (range = 65-89) and 96.9% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. The researchers examined associations between OS and PFS and the following geriatric domains at baseline:

  • functional status, including activities of daily living (ADL), instrumental activities of daily living (IADL), timed “up and go,” and number of falls in the last 6 months
  • psychological status (Mental Health Inventory)
  • social activity (Medical Outcomes Study Social Activity Survey)
  • cognition (Blessed Orientation Memory Concentration Test)
  • social support (Medical Outcomes Study Social Support Tangible and Emotional/Informational subscales)
  • nutritional status (>5% weight loss in the previous 6 months)

The following domains were significantly associated with improved OS:

  • better functional status (ADL score: hazard ratio [HR] = 0.67 (0.49-0.92), p=0.012; IADL score: HR=0.98 (0.97-0.99), p=0.007)
  • social activity score (HR=0.97 (0.96-0.99), p=0.004)
  • nutritional status (HR=2.58 (1.28-5.21), p=0.008).

These domains also were significantly associated with improved PFS:

  • functional status (ADL score: HR=0.77 (0.62-0.97), p=0.028; IADL score: HR=0.99 (0.97-1.00), p=0.007)
  • social activity score (HR=0.97 (0.96-0.98), p<0.001)
  • nutritional status (HR=2.87 (1.82-4.52), p<0.001)

The researchers also found that the number of impaired domains a patient had at baseline was associated with both OS (HR=1.50, p=0.004) and PFS (HR=1.45, p<0.001).

“Pretreatment geriatric assessments of functional status, social activity, and nutritional status provide clinicians with important prognostic information regarding clinical outcomes in older adults with CLL,” Ms. Rice concluded. She added that future studies should examine the role of pre-habilitation programs and geriatric assessment in improving quality of life for patients with CLL.

The authors report no relevant conflicts of interest.

Reference

Rice J, Nipp RD, Lage DE, et al. Association between baseline geriatric domains and survival in older adults with chronic lymphocytic leukemia (CLL). Abstract #12041. Presented at the 2021 American Society of Clinical Oncology Annual Meeting, June 4-8, 2021.