Younger Vs Older B-Cell NHL Survivors Show Increased Risk of Adverse Health Outcomes

Contemporary Concepts | <b>Contemporary Concepts in Hematologic Oncology</b>

Younger survivors of B-cell non-Hodgkin lymphoma appeared to have an increased risk of adverse health outcomes 5 or more years after diagnosis compared with older survivors.

Five years or more following a diagnosis, younger survivors of B-cell non-Hodgkin lymphoma reportedly had an increased risk of adverse health outcomes compared with older survivors, according to a study published in Cancer Epidemiology, Biomarkers, & Prevention.

When survivors were compared with the general population, investigators observed an increased risk of renal failure (HR, 2.24; 99% CI, 1.48-3.39; Pheterogeneity = .017), pneumonia (HR, 2.42; 99% CI, 1.68-3.49; Pheterogeneity = .055), and nutritional deficiencies (HR, 2.08; 99% CI, 1.48-2.92; Pheterogeneity = .051) in younger survivors vs older survivors at 5 years or more after diagnosis.

“Our study is the first to examine risks for a range of adverse health outcomes associated with aging, using International Classification of Diseases codes for B-cell non-Hodgkin lymphoma survivors by age groups compared with individuals from their respective general population cohorts in a large-scale population-based study,” investigators of the study wrote.

In total, 44.7% of survivors were diagnosed between the ages of 45 to 64 years, and 35.1% were diagnosed between the ages of 65 to 80 years. After 5 years or more following diagnosis, almost 60% of older survivors and 85.6% of younger survivors were alive. Investigators reported that 13.2% of younger survivors and 27.1% of older survivors had preexisting comorbidities at baseline, and 41.9% and 44.1% of younger and older survivors respectively were overweight.

Most patients received chemotherapy alone, inclduing 41.5% of patients in the younger group and 38.7% in the older group. Additionally, 25.3% of younger survivors and 34.5% of older survivors had no first-course treatment. Hematopoietic cell transplant was used in 11.4% of younger survivors and 2.0% of older survivors.

During the study, investigators found that older survivors had an elevated risk of chronic obstructive pulmonary disease and chronic airway obstruction compared with the older general population; disease risks were not considered significant in the younger population. Younger individuals had an increased risk of developing chronic kidney disease and urinary tract infections vs the younger general population.

It was found that radiotherapy and combination chemotherapy/radiotherapy were risks factor for nutritional deficiencies, and hematopoietic cell transplantation was a risk factor for pneumonia in older vs younger survivors. Additionally, having multiple pre-existing comorbidities was considered to be a risk factor for acute renal failure.

Investigators reported that those who were younger with acute renal failure, pneumonia, and nutritional deficiencies had a higher risk of death than those who are younger without these prespecified adverse health outcomes.

Investigators also considered heart disease and second malignancies to be potential risk factors but found no significant difference between models. Moreover, with heart disease as a competing risk factor, a 1.94-fold risk of chronic kidney disease was observed in younger survivors (99% CI, 1.41-2.68) vs older survivors (HR, 1.16; 99% CI, 0.90-1.50; Pheterogeneity = .014). When second malignancies were considered as a competing risk factor, younger survivors had a 2.01-fold risk of developing chronic kidney disease (99% CI, 1.45-2.78) than older survivors (HR, 1.20; 99% CI, 0.92-1.56; Pheterogeneity = .016). When investigators did not consider heart disease and second malignancies as competing risk factors, the HRs for chronic kidney disease were 2.29 (99% CI, 1.49-3.52) and 1.37 (99% CI, 0.97-1.93) for younger and older survivors, respectively (Pheterogeneity = .067.

Reference

Ocier K, Abdelaziz S, Kim S, et al. Age-related disease risks in younger versus older B-cell non-Hodgkin's lymphoma survivors. Cancer Epidemiol Biomarkers Prev. 2021;30(12):2268-2277. doi:10.1158/1055-9965.EPI-21-0190