Charlson Comorbidity Index is an independent prognostic factor among elderly patients with diffuse large B-cell lymphoma

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Abstract
The clinical outcome for elderly patients with diffuse large B-cell lymphoma (DLBCL) has improved. However, the management of elderly patients with cancer is frequently complicated by their coexisting disorders. The aim of this study was to evaluate the correlation between comorbid medical status and clinical outcome among elderly patients with DLBCL. We retrospectively analyzed all patients over 65 years old with newly diagnosed DLBCL from 2001 to 2008 in our institution. To assess their comorbid medical status, we calculated Charlson Comorbidity Index (CCI) of each patient without considering primary disease and then divided them into low CCI (0 or 1) or high CCI group (2 or more). A total of 80 patients from age of 66–90 years (median 73 years) were analyzed. Seventy-two patients (90%) were treated with cyclophosphamide-, doxorubicin-, vincristine-, and prednisone (CHOP)-based chemotherapy, and 14 patients (18%) were assigned to high CCI. The overall survival (OS) rate at 3 years for all patients was 70%, with significant difference between good and poor risk patients in revised International Prognostic Index (IPI) (90 vs. 45%, P < 0.0001). Multivariate analysis revealed high CCI was associated with worse OS, while independent of other prognostic factors consisting IPI (hazard ratio 4.44, 95% confidence interval [1.63–11.3], P = 0.0045). In addition, high CCI group was significantly inferior to low CCI group for overall response rate (93 vs. 64% P = 0.0158) and 3-year OS (85 vs. 55% P = 0.0026), respectively. Among elderly DLBCL, high CCI was independently associated with worse outcome. Novel discrete strategies for these deteriorated patients are therefore warranted.

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