Impact of comorbidities on the treatment of non-Hodgkin’s lymphoma: a systematic review

Abstract

Treating non-Hodgkin’s lymphoma in patients with comorbidities can be challenging because of possible interactions that may alter the treatment efficacy. We conducted a systematic review to determine the impact of comorbidities on various outcomes, evaluate the current data, and provide recommendations for future research. Twenty-one articles were selected. However, the study populations and design were greatly heterogeneous, and the quality of reporting was generally weak. The majority of studies demonstrated significant impact of comorbidity on survival, reporting poorer survival rates for patients with comorbidities compared to those with no comorbidities. However, the existing evidence is limited and of insufficient quality to establish solid conclusions and to guide treatment decisions. Prospective, well-designed studies are warranted.

Keywords:

• chemotherapy
• comorbidity
• diffuse large B-cell lymphoma
• geriatric assessment
• malignant lymphoma
• non-Hodgkin’s lymphoma

Financial & competing interests disclosure

The authors thank P McKelvie-Sebileau of Institut Bergonié for medical editorial assistance. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Evaluation of comorbidities is frequently performed but poorly integrated within the decision-making process.

• Comorbidity assessment methods varied hugely, which compromises adequate comparison between studies.

• Treatment regimens in older patients with non-Hodgkin’s lymphoma (NHL) greatly differ according to physicians’ opinion in terms of drugs and dosages, which also alter the quality of comparison between studies. Comorbidity interacts with treatment decision making in NHL.

• NHL patients with comorbidities are generally older patients who should benefit from geriatric assessment.

• Comorbidity influences survival in patients with malignant lymphoma. However, available evidence is poor and highly heterogeneous.

• Further studies should integrate a common validated assessment method to evaluate comorbidity and to allow legitimate comparisons.