Effectiveness of Multi-Prognostic Index in older patients with advanced malignancies treated with immunotherapy

Abstract Background Multidimensional Prognostic Index (MPI) is useful as a prognostic tool in hospitalized older patients, but our knowledge is derived from retrospective studies. We therefore aimed to evaluate in a multicenter, longitudinal, cohort study whether the MPI at hospital admission is useful to identify groups with different mortality risk and whether MPI at discharge may predict institutionalization, rehospitalization, and use of home care services during 12 months. Methods This longitudinal study, carried out between February 2015 and August 2017, included nine public hospitals in Europe and Australia. A standardized comprehensive geriatric assessment including information on functional, nutritional, cognitive status, risk of pressure sores, comorbidities, medications, and cohabitation status was used to calculate the MPI and to categorize participants in low, moderate, and severe risk of mortality. Data regarding mortality, institutionalization, rehospitalization, and use of home care services were recorded through administrative information. Results Altogether, 1,140 hospitalized patients (mean age 84.1 years, women = 60.8%) were included. In the multivariable analysis, compared to patients with low risk group at admission, patients in moderate (odds ratio [OR] = 3.32; 95% CI: 1.79–6.17; p < .001) and severe risk (OR = 10.72, 95% CI: 5.70–20.18, p < .0001) groups were at higher risk of overall mortality. Among the 984 older patients with follow-up data available, those in the severe-risk group experienced a higher risk of overall mortality, institutionalization, rehospitalization, and access to home care services. Conclusions In this cohort of hospitalized older adults, higher MPI values are associated with higher mortality and other negative outcomes. Multidimensional assessment of older people admitted to hospital may facilitate appropriate clinical and postdischarge management.

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Using the multidimensional prognostic index for treatment decisions and monitoring in frail older patients

Geriatric Care ◽

10.4081/gc.2017.7059 ◽

2017 ◽

Vol 3 (3) ◽

Cited By ~ 1

Author(s):

Arduino A. Mangoni

Keyword(s):

Clinical Guidelines ◽

Older Patients ◽

Management Strategies ◽

Treatment Strategies ◽

Prognostic Index ◽

End Points ◽

Disease States ◽

Safe Management ◽

Limited Life ◽

Poor Functional Status

The routine applicability of clinical guidelines and disease-specific end-points in frail older patients is problematic because of the exclusion of this group from clinical trials, their limited life expectancy, the co-existence of multiple disease states and poor functional status, and the presence of complex drug-drug and drug-disease interactions. In this context, the use of patient-centred end-points that include measures of quality of life might be particularly useful for designing tailored treatment strategies, monitor progress and, ultimately, improve outcomes. The multidimensional prognostic index, an objective, quantifiable, and validated scoring system based on core domains of the comprehensive geriatric assessment, might represent an important tool for the development of clinical guidelines that take into account measures of frailty and patientcentred end-points. However, research is warranted to investigate whether this approach leads to more effective and safe management strategies in old age.

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Comprehensive geriatric assessment in older patients with cancer: an external validation of the multidimensional prognostic index in a French prospective cohort study

BMC Geriatrics ◽

10.1186/s12877-020-01692-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Evelyne Liuu ◽

Chunyun Hu ◽

Simon Valero ◽

Thomas Brunet ◽

Amelie Jamet ◽

...

Keyword(s):

Cohort Study ◽

Geriatric Assessment ◽

Prospective Cohort Study ◽

Comprehensive Geriatric Assessment ◽

Prospective Cohort ◽

Older Patients ◽

External Validation ◽

Prognostic Index ◽

Patients With Cancer

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Usefulness of the multidimensional prognostic index (MPI) in the management of older patients with chronic kidney disease

Journal of Nephrology ◽

10.5301/jn.5000162 ◽

2012 ◽

Vol 25 (Suppl. 19) ◽

pp. 79-84 ◽

Cited By ~ 11

Author(s):

Alberto Pilotto ◽

Francesco Panza ◽

Daniele Sancarlo ◽

Giulia Paroni ◽

Stefania Maggi ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Older Patients ◽

Prognostic Index

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Polypharmacy and potentially inappropriate medication use in older patients with aggressive non-Hodgkin lymphoma (NHL) leads to inferior survival and increased treatment-related toxicities.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10039 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10039-10039 ◽

Cited By ~ 1

Author(s):

Richard Jirui Lin ◽

Helen Ma ◽

Robin Guo ◽

Michael L. Grossbard ◽

Andrea B. Troxel ◽

...

Keyword(s):

Older Patients ◽

Inappropriate Medication ◽

International Prognostic Index ◽

Tumor Biology ◽

Prognostic Index ◽

Dose Intensity ◽

Progression Free Survival ◽

Rank Test ◽

Potentially Inappropriate Medications ◽

Grade 3

10039 Background: Survival outcomes for older patients with aggressive NHL are disproportionally inferior to those of younger patients. While differences in tumor biology may play a role, older patients are often frail with comorbidities, polypharmacy, and use potentially inappropriate medications (PIM) such as anticholinergics and benzodiazepines. Methods: Using Cox proportional hazard and logistic regression models, we analyzed all aggressive NHL patients age ≥60 treated at our two affiliated hospitals from 2009-2014 to examine the association of polypharmacy and PIM use with progression-free survival (PFS), overall survival (OS), and treatment-related toxicities. Results: In this updated and final analysis, we included 171 patients with complete records from these two hospitals. They share similar demographic, clinical, and laboratory characteristics except for higher International Prognostic Index (IPI) in patients from one hospital. The median age was 70 years (range 65-77). At the time of diagnosis, 46% of patients used more than 4 medications (polypharmacy) and 47% used at least one PIM. Only 43% of patients received first-line chemotherapy of adequate relative dose intensity (>85% dosage), and 65% experienced ≥grade 3 toxicities. Polypharmacy and PIM use were associated with shortened PFS and OS by log-rank test. Most importantly, PIM use remained an independent predictor of PFS, OS, and ≥ grade 3 toxicities in multivariable analyses (Table). Conclusions: This is the first report of significantly adverse survival impacts of polypharmacy and PIM use in older patients with aggressive NHL, presumably from drug-drug interactions that increase toxicities and impair the delivery of adequate chemotherapy dosage. Our findings support the use of evidence-based geriatric principles to guide meticulous medication management to improve outcome disparity for these patients. [Table: see text]

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Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP

Blood Advances ◽

10.1182/bloodadvances.2021004286 ◽

2021 ◽

Vol 5 (8) ◽

pp. 2229-2236

Author(s):

Toby A. Eyre ◽

William Wilson ◽

Amy A. Kirkwood ◽

Julia Wolf ◽

Catherine Hildyard ◽

...

Keyword(s):

Older Patients ◽

Rating Scale ◽

International Prognostic Index ◽

Prognostic Index ◽

Dose Intensity ◽

B Cell Lymphoma ◽

Morbidity And Mortality ◽

Risk Of Infection ◽

Increased Risk

Abstract Infection-related morbidity and mortality are increased in older patients with diffuse large B-cell lymphoma (DLBCL) compared with population-matched controls. Key predictive factors for infection-related hospitalization during treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and deaths as a result of infection in older patients during and after treatment with R-CHOP remain incompletely understood. For this study, 690 consecutively treated patients age 70 years or older who received full-dose or attenuated-dose R-CHOP treatment were analyzed for risk of infection-related hospitalization and infection-related death. Median age was 77 years, and 34.4% were 80 years old or older. Median follow-up was 2.8 years (range, 0.4-8.9 years). Patient and baseline disease characteristics were assessed in addition to intended dose intensity (IDI). Of all patients, 72% were not hospitalized with infection. In 331 patients receiving an IDI ≥80%, 33% were hospitalized with ≥1 infections compared with 23.3% of 355 patients receiving an IDI of <80% (odds ratio, 1.61; 95% confidence interval, 1.15-2.25; P = .006). An increased risk of infection-related admission was independently associated with IDI >80% across the whole cohort. Primary quinolone prophylaxis independently reduced infection-related admission. A total of 51 patients died as a result of infection. The 6-month, 12-month, 2-year, and 5-year cumulative incidences of infection-related death were 3.3%, 5.0%, 7.2%, and 11.1%, respectively. Key independent factors associated with infection-related death were an International Prognostic Index (IPI) score of 3 to 5, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score ≥6, and low albumin, which enabled us to generate a predictive risk score. We defined a smaller group (15%) of patients (IPI score of 0-2, albumin >36 g/L, CIRS-G score <6) in which no cases of infection-related deaths occurred at 5 years of follow-up. Whether patients at higher risk of infection-related death could be targeted with enhanced antimicrobial prophylaxis remains unknown and will require a randomized trial.

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