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Objective:To evaluate the prognostic effects of two comprehensive geriatric assessment (CGA) methods in elderly patients with acute myeloid leukemia (AML).Methods:Ninety-seven patients with newly diagnosed AML at Beijing Hospital from August 2008 to December 2019 were included (≥60 years old). All patients were evaluated by two methods of CGA. One was IACA index proposed by Beijing Hospital, including instrumental activities of daily living (IADL), age, Charlson comorbidity index (CCI), albumin; the other was proposed by Italian FIL study group (FIL-CGA), including activities of daily living (ADL), IADL, age, and modified cumulative illness rating score for geriatrics (MCIRS-G).Results:Among 97 patients, 54 patients received standard chemotherapy, 16 with decitabine, 2 with targeted therapy and 25 with the best supportive therapy. The overall response rate (ORR) in 72 treated patients were 67.7%, 33.3% and 0 respectively in fit, unfit and frail groups according to IACA index ( P=0.001). Based on FIL-CGA, the ORRs of fit, unfit and frail groups were 52.5%, 41.7% and 35.0% respectively ( P=0.418). The 1-year OS rates of fit, unfit and frail groups regarding IACA method were 78.7%, 27.7% and 0 respectively ( P<0.01). The 1-year OS rates of fit, unfit and frail groups regarding FIL-CGA method were 67.8%, 28.2% and 13.9% respectively ( P<0.01), while no significant difference was seen between unfit group and frail group ( P=0.111). The early death rates of fit, unfit and frail groups by IACA were 0, 6.0% and 28.6% respectively ( P=0.006), while those by FIL-CGA were 2.3%, 5.9%, 13.9% respectively ( P=0.123). Conclusion:Compared with FIL-CGA method, IACA predicts more effectively the treatment response, survival and early mortality in elderly patients with AML.
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Objective@#To evaluate the prognostic significance of comprehensive geriatric assessment (CGA) in Chinese elderly acute myeloid leukemia (AML) patients.@*Methods@#73 AML patients over the age of 60 were enrolled. CGA stratification included the following 3 instrument assessment: activity of daily living (ADL) ; instrumental activity of daily living (IADL) ; comorbidity score according to the Modified cumulative illness rating score for geriatrics (MCIRS-G) . According to CGA and age, the enrolled patients were grouped into 'fit’, 'unfit’ and 'frail’ categories.@*Results@#The median age of 73 elderly AML patients were 75 years old. According to CGA, 37 (50.1%) patients were classified as 'fit’, 14 (19.2%) as 'unfit’, and 22 (30.7%) as 'frail’. 33 (89.2%) patients in fit group received induction chemotherapy, or demethylation treatment, as 8 (57.9%) in unfit, 10 (45.5%) in frail. The overall response rate was 68.7%、62.5%, 75.0% in fit, unfit, and frail group, respectively (χ2=0.615, P=0.769) .The early mortality (8 weeks) in three groups were different: 5.4%, 7.1%, 27.3%, respectively (P<0.05) . The 1-year overall survival in the 'fit’, 'unfit’ and 'frail’ groups was 64.9%, 28.6% and 22.7%, respectively (P<0.05) . The CGA score, age, ECOG score, WHO classification (2016) were the prognostic factors of AML patients.@*Conclusion@#CGA can be used to determine the prognosis of elderly AML patients.
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Objective To investigate the clinical characteristics of diffuse large B-cell lymphoma (DLBCL) and to evaluated the predictive value of comprehensive geriatric assessment (CGA)in advanced-aged DLBCL patients.Methods A total of 24 patients aged 80 years and over diagnosed with DLBCL in our hospital from March 2010 to July 2017 were enrolled in this study.CGA included three parts:age,activities of daily living(ADL)/instrumental activities of daily living(IADL)and comorbidity evaluated by the cumulative illness rating score for geriatrics(CIRS-G).According to CGA scores,all patients were classified into either the not-applicable group or the frail group.Results There were 10 and 14 patients in the not-applicable group and the frail group,respectively.Twenty-two patients received chemotherapy,and the incidences of toxicity after chemotherapy were comparable between the two groups.Nine patients achieved complete remission (CR),five patients partial remission(PR),and the overall response rate(ORR) was 63.6 ％.The not-applicable group seemed to have a higher complete remission rate than the frail group(60.0 ％ vs.25.0 ％,x2=2.764,P =0.192).However,the overall response rates were comparable between the two groups.Treatment-related deaths occurred in 2 and 3 patients(20.0 ％ vs.25.0 ％,x2 =0.078,P =1.000)in the not-applicable and frail groups,respectively.Relapse/progression-related deaths occurred in 3 and 5 patients in the not-applicable and frail groups(30.0％ vs.41.7％,x2 =0.321,P =0.675),respectively.The 2-year overall survival rates and progression-free survival rates were 56.3 ％ versus 35.2 ％ (x2 =0.635,P =0.426)and 42.2 ％ versus 16.7 ％ (x2 =2.156,P =0.142) in the not-applicable and frail groups,respectively.Conclusions Advanced-aged patients with DLBCL have a poor prognosis,which can be predicted by CGA to a certain extent.Further improvement in the current CGA scoring system is still needed to accurately predict the prognosis of DLBCL in advanced-aged patients and to guide treatment.
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Objective To evaluate the performance on comprehensive geriatric assessment (CGA) in elderly patients with acute myeloid leukemia (AML)and to investigate the differences between Eastern Cooperative Oncology Group (ECOG) performance status (PS) and CGA scoring.Methods Patients aged 60 years or over diagnosed with AML at Beijing Hospital from September 2008 to April 2018 were enrolled in this study.CGA was performed during staging procedures through application of age,activities of daily living(ADL)/instrumental activities of daily living(IADL)and the comorbidity score based on the cumulative illness rating scale for geriatrics(CIRS-G).According to CGA scores,patients were classified into a not-applicable group,an applicable group and a frail group.The difference between ECOG-PS and CGA scoring was compared.Results A total of 73 patients were enrolled in this study.There were 37 (50.7 ％),14 (19.2 ％) and 22 (30.1％) patients in the applicable,not-applicable and frail groups,respectively.Comorbidities were observed in the majority of patients,with cardiovascular disease,diabetes mellitus and hypertension among the most common disorders.In patients aged 60 to 64 years,16.7％ (1/6) were considered as frail,and the percentage of frail patients increased to 36.4％ (8/22)in patients aged 80 years and over.Moreover,functional impairment evaluated by CGA was observed in 36.5 ％ (19/52)of patients with ECOG-PS ≤ 1.Conclusions According to CGA scoring,approximately half of AML patients aged 60 years or over have functional impairment.Functional impairment is observed in some patients with ECOG-PS ≤1,indicating that ECOG-PS may underestimate functional impairment in elderly AML patients.
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Objective To measure the comprehensive geriatric assessment (CGA) in elder non-Hodgkin's Lymphoma (NHL) patients in a cross-sectional study;to compare the differences between Eastern Cooperative Oncology Group (ECOG)-performance status (PS) and CGA.Methods CGA stratification included the following 3 instrument assessments:activity of daily living (ADL);instrumental activity of daily living (IADL);comorbidity score according to the modified cumulative illness rating score for geriatrics (MCIRS-G).According to CGA and age,NHL patients,aged ≥60 years,were classified as "fit","unfit" and "frail" groups.ECOG-PS was evaluated and compared with CGA.Results According to CGA,51.6％ senior NHL patients (33 cases) were classified as "fit",12.5％(8 cases) as " unfit" and 35.9％ (23 cases) as "frail".Several comorbidities were observed in majority patients,such as cardiovascular disease,diabetes nellitus and hypertension.In the "younger aged" patients between 60 to 64ys,25％(3/12) was considered as "frail".However,this proportion increased to 42.9％ (6/14) in patients older than 80ys.Moreover,impaired CGA was observed in 38.9％(21/54) of ECOG-PS ≤1 patient.Conclusions Impaired CGA is as common as approximately half in elderly NHL patients and more than one third even in ECOG-PS ≤ 1 patients.ECOG-PS may underestimate the impaired fitness function in elder NHL patients.
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The incidence of hematologic malignancies in elderly is increasing year by year. So for clinicians, it is a problem to assess the tolerance to chemotherapy of elderly patients with hematological cancer. Recently, the comprehensive geriatric assessment has begun to be used in elderly patients with hematological malignancies. The studies have found that the comprehensive geriatric assessment could be used to assess the prognosis, predict the patient's tolerance to treatment, and may also be used as guidelines for making treatment decision. This paper mainly reviews the research status of comprehensive geriatric assessment in elderly patients with hematological malignancies at home and abroad.
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Objective To evaluate the feasibility of using comprehensive geriatric assessment (CGA) in estimating if standard dose treatment is fit for the elderly patients with diffuse large B cell lymphoma.Methods.Comprehensive geriatric assessments including three assessments of activity of daily living,instrumental activity of daily living and comorbidity scoring according to Cumulative Illness Rating Score for Geriatrics were adopted to assess if standard dose treatment is fit for the elderly patients in our prospective study.Thirty seven patients with diffuse large B cell lymphoma,aged ＞70 years were enrolled in the study,and grouped into fit,unfit and frail groups according to comprehensive geriatric assessment scoring and their age.The treatment protocolswere not determined by comprehensive geriatric assessment scores,but by clinical judgments made by clinicians based on their clinical experience and disease features.The clinically effective response and overall survival (OS) were analyzed in the three groups.Results According to CGA scores,patients were grouped into fit [21 cases (56.8％)],unfit [7 (18.9％)] and frail [9 (24.3％)].37 cases received 213 courses of treatment at average 5.76 courses per case.The overall response (complete / partial remission) rates were [85.7％(18/21) vs.28.6％ (2/7) vs.44.4％ (4/9),x2=9.69,P=0.008] and median survival times were (44 months vs.10 months vs.9 months;x2 =7.03,P=0.03) among fit,unfit and frail groups with statistically significant differences.Total effective rate (achieving all clinical targets) in fit group of 21 cases were 100 ％ (12/12)with receiving standard dose therapy,and 66.7％ of(6/9)with low dose therapy(P=0.06).Overall response rate(total/partial remission) [85.7％(18/21) vs.28.6％(2/7) vs.44.4％(4/9),x2=9.69,P=0.008] and median survival (44 months vs.10 months vs.9 months;x2 =7.03,P=0.03) amongfit,unfit and frail groups.In fit group,the two-year overall survival was higher in patients receiving standard dose treatment than receivingpalliativetreatment,with statistical significance [83.3 ％ (10/12) vs.33.3 ％ (3/9),P =0.032],without significant hematologic toxicity observed between the subgroups.Conclusions Comprehensive geriatric assessment can identify if elderly patients diffuse large B cell lymphoma can acquire a satisfactory curative effect from a standard dose treatment ofimmunochemotherapy.
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<p><b>OBJECTIVE</b>To evaluate three methods of ¹⁸F-FDG PET/CT in detecting bone marrow infiltration in patients with newly diagnosed diffuse large B-cell lymphoma.</p><p><b>METHODS</b>Seventy-seven patients with newly diagnosed diffuse large B-cell lymphoma from July 2012 to June 2014 were retrospectively analyzed. All patients received both ¹⁸F-FDG PET/CT scan and bone marrow biopsy in the region of the posterior iliac crests. There were three evaluation methods of ¹⁸F-FDG PET/CT to detect bone marrow infiltration, including visual comparison (the FDG uptake in bone marrow of iliac crests was higher than the normal liver tissue), the maximal standardized uptake values (SUV(max)) in bone marrow of iliac crests (more than or equal to 2.5), the ratio of maximal standardized uptake values of iliac crests bone marrow to liver parenchyma intensity (more than 1). All results were compared with the bone marrow biopsy.</p><p><b>RESULTS</b>Visual comparison of ¹⁸F-FDG PET/CT could be used to diagnose bone marrow infiltration, with the sensitivity of 100.00%, specificity of 80.00%, positive predictive value of 48.00%, and negative predictive value of 100.00%. When the SUV(max) of iliac crests was used as the diagnostic threshold, the sensitivity was 75.00%, with 92.31% specificity, 64.29% positive predictive value, and 95.24% negative predictive value. The ratio of SUV(max) had the best diagnostic efficiency, with sensitivity of 100.00%, specificity of 90.77%, positive predictive value of 66.67%, and negative predictive value of 100.00%.</p><p><b>CONCLUSION</b>The ratio of SUV(max) is a valuable diagnostic method in detecting diffuse large B-cell lymphoatic bone marrow involvement.</p>
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Humans , Biopsy , Bone Marrow , Fluorodeoxyglucose F18 , Lymphoma, Large B-Cell, Diffuse , Multimodal Imaging , Positron-Emission Tomography , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective To analyze the association of the morbidity,the management of blood glucose,and the prognosis of patients with hyperglycemia in the medical intensive care units(ICU).Methods Medical records of ICU patients of Renji Hospital from 2002 to 2009 were reviewed using Medical Record Inquiry System,and the data were retrospectively analyzed.Results(1)2631 subjects were included in the present study,blood glucose was determined at least once during hospitalization in 2168 of them.The incidence of hyperglycemia was 26.3%,in which 12.9% presented a known history of diabetes and 13.4% without.In the patients with diabetes history,93.2% of them received anti-diabetic treatment during hospitalization.mainly with oral anti-hyperglyeemic agents (53.0%)or subcutaneous insulin injection(24.9%).However,in the patients without diabetes history,84.4% were not treated against hyperglycemia.The mortality was increased in the latter group(30.4% vs13.9%,P<0.01).(2)In the patients with diabetes history,the mortality in patients whose blood glucose>10 mmol/L was higher than those with blood glucose≤7.0 mmol/L(20.5% vs 9.9%,P<0.05):while in the patients without diabetes history,the mortality began to rise as blood glucose>7.0 mmol/L(P<0.01).(3)Multiple stepwise regression analysis revealed that the average blood glucose level was an independent risk factor for death(OR=1.26).Conclusions The ICU patients showed a high prevalence of hyperglycemia,the management of hyperglycemia should be emphasized.Hyperglycemia in critically ill patients might be an independent risk factor of increased mortality.