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

T Wästerlid; M Mohammadi; K E Smedby; I Glimelius; M Jerkeman; M Bottai; S Eloranta

doi:10.1111/joim.12849

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

J Intern Med. 2019 Apr;285(4):455-468. doi: 10.1111/joim.12849. Epub 2018 Nov 8.

Authors

T Wästerlid^{1

2}, M Mohammadi³, K E Smedby^{1

2}, I Glimelius^{1

4}, M Jerkeman⁵, M Bottai³, S Eloranta¹

Affiliations

¹ Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
² Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
³ Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden.
⁴ Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden.
⁵ Department of Oncology, Lund University Hospital, Lund, Sweden.

PMID: 30368947
DOI: 10.1111/joim.12849

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.

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 (HR_CCI_>1 : 1.54, 95% CI: 1.32-1.80), but not with lymphoma-specific death (HR_CCI_>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.

Keywords: comorbidity; diffuse large B-cell lymphoma; prognosis; treatment.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death
Comorbidity
Disease-Free Survival
Female
Humans
Lymphoma, Large B-Cell, Diffuse / complications*
Lymphoma, Large B-Cell, Diffuse / epidemiology
Lymphoma, Large B-Cell, Diffuse / mortality
Lymphoma, Large B-Cell, Diffuse / therapy
Male
Middle Aged
Registries
Survival Analysis
Sweden
Treatment Outcome
Young Adult