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Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B-cell lymphoma: a Swedish lymphoma register study
Karolinska Inst, Div Clin Epidemiol, Dept Med Solna, Stockholm, Sweden;Karolinska Univ Hosp, Stockholm, Sweden;Karolinska Univ Hosp, Dept Hematol, Stockholm, Sweden.
Karolinska Inst, Div Epidemiol, Inst Environm Med, Stockholm, Sweden.
Karolinska Inst, Div Clin Epidemiol, Dept Med Solna, Stockholm, Sweden;Karolinska Univ Hosp, Stockholm, Sweden;Karolinska Univ Hosp, Dept Hematol, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Karolinska Inst, Div Clin Epidemiol, Dept Med Solna, Stockholm, Sweden;Karolinska Univ Hosp, Stockholm, Sweden.
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2019 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 285, no 4, p. 455-468Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2019. Vol. 285, no 4, p. 455-468
Keywords [en]
comorbidity, diffuse large B-cell lymphoma, prognosis, treatment
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-382255DOI: 10.1111/joim.12849ISI: 000462607700011PubMedID: 30368947OAI: oai:DiVA.org:uu-382255DiVA, id: diva2:1313513
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-05-03Bibliographically approved

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