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  • 1
    Language: English
    In: Journal of Cancer Research and Clinical Oncology, 2011, Vol.137(4), pp.733-738
    Description: Byline: Nils Winkelmann (1), Iver Petersen (2), Michael Kiehntopf (3), Hans Joerg Fricke (1), Andreas Hochhaus (1), Ulrich Wedding (1) Keywords: Geriatric assessment; Malignant lymphoma; Comorbidity; Survival; Prognostic value Abstract: Purpose The prevalence of elderly and comorbid patients (pts) with malignant lymphoma (ML) will steadily increase in future. Elderly patients comprise a heterogeneous population. Comprehensive geriatric assessment (CGA) is an established diagnostic tool in geriatric medicine. However, the prognostic value in patients with ML is unclear. We sought to establish a relationship between results of CGA and survival time in patients with ML. Methods Newly diagnosed patients with ML and indication for chemotherapeutical treatment were prospectively recruited in an observational trial. In addition to usual diagnostic work up, a CGA including activities of daily living (ADL), instrumental activities of daily living (IADL) and comorbidities was performed. Association of patients' characteristics and results of CGA with survival were analysed according to Kaplan--Meier method and in a multivariate Cox-regression analysis. Results About 143 patients were included, median age was 63 years, 63 patients were women. Median follow-up of surviving patients was 62 months. Sixty-six patients died within this time. Advanced age, poor Karnofsky performance status, dependence in ADL and IADL and presence of severe comorbidity were significantly associated with shorter survival time. In a Cox-regression analysis, IADL (HR 2.1 95% CI 1.1--3.9) and comorbidity (HR 1.9 95% CI 0.9--3.9) were independent and strongest associated with survival time. Conclusion Results of CGA, such as IADL and comorbidities, are prognostic variables for survival of patients with ML. Results should be validated in homogeneous clinical groups and if confirmed included in diagnostic and therapeutic algorithm. Author Affiliation: (1) Klinik fur Innere Medizin II, Abteilung Hamatologie und internistische Onkologie, Universitatsklinikum Jena, Erlanger Allee 101, 07747, Jena, Germany (2) Institut fur Pathologie, Universitatsklinikum Jena, Ziegenmuhlenweg 1, 07743, Jena, Germany (3) Institut fur Klinische Chemie und Laboratoriumsdiagnostik, Universitatsklinikum Jena, Erlanger Allee 101, 07747, Jena, Germany Article History: Registration Date: 18/06/2010 Received Date: 27/05/2010 Accepted Date: 18/06/2010 Online Date: 03/07/2010
    Keywords: Geriatric assessment ; Malignant lymphoma ; Comorbidity ; Survival ; Prognostic value
    ISSN: 0171-5216
    E-ISSN: 1432-1335
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  • 2
    Language: English
    In: Journal of Cancer Research and Clinical Oncology, 2006, Vol.132(10), pp.665-671
    Description: Acute myeloid leukaemia (AML) is mainly affecting elderly patients. Elderly patients are increasingly affected by impairment of functional status (FS). FS is of prognostic relevance for survival in different tumours. Data for patients with AML are rare. Within a prospective trial we recruited patients with newly diagnosed AML and measured FS by two different methods: Karnofsky performance status (KPS) and instrumental activities of daily living (IADL). Sixty-three patients aged 19–85 years (median 61.1) were included. Twenty-three had prior myelodisplastic syndrome (MDS), 7 favourable, 17 unfavourable karyotype. Fifty received induction chemotherapy, 13 palliative chemotherapy. Median survival was 15.2 months (95% CI, 10.8–22.3) in all patients. Age, cytogenetic risk group, and impaired KPS and IADL significantly influenced median survival in univariate analysis. Impairment of IADL was the single most predictive variable. In multivariate analysis, impairment of IADL Score (HR:4.3, 95% CI 1.7–10.5, P  = 0.001) and of KPS (HR:4.8, 95% CI 1.9–12.3, P  = 0.001), and unfavourable cytogenetic risk group (HR:6.0, 95% CI 2.5–14.3, P  〈 0.001) significantly predicted median survival. In patients with AML, FS and not age is a major predictor of survival. The influence of FS is independent from cytogenetic risk group. IADL measurement adds information to KPS. The results have to be confirmed in a large sample of patients.
    Keywords: Acute myeloid leukaemia ; Functional status ; Chemotherapy ; Geriatric assessment ; Survival
    ISSN: 0171-5216
    E-ISSN: 1432-1335
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