Novel Risk Score Assesses Survival in NHL

A novel three-factor risk estimate scale (TRES) that provides clinicians with a simple-to-use, clinically adaptable comorbidity assessment tool for measuring survival in patients with non-Hodgkin lymphoma (NHL) was proposed during a poster presentation at the 2022 American Society of Hematology Annual Meeting.

TRES was developed because the “lack of a standardized measure and the complexity of available scores has hindered the formal assessment of comorbidities in patients with NHL,” according to the investigators, led by Max J. Gordon, MD, of the University of Texas MD Anderson.

The scale is based on the chronic lymphocytic leukemia comorbidity index (CLL-CI), which was developed earlier by the same team. CLL-CI uses a score range of zero to three and assesses medical conditions in vascular, endocrine, and upper gastrointestinal categories. The researchers hypothesized that the CLL-CI would be associated with survival in NHL more generally as well as CLL specifically and therefore changed the name from “CLL-CI” to TRES score.

To test the association between mortality and TRES scores, the researchers evaluated the TRES scores of 40,486 patients in the Surveillance, Epidemiology, and End Results-Medicare linked database who were aged 65 and older and diagnosed with NHL between 2008 and 2017. The scores were calculated for the 12 months preceding NHL diagnosis using the International Classification of Diseases, 9/10 index; procedure codes; and prescription information from Medicare part A, B, and D claims. One point was assigned for each medical condition in each category for a maximum score of three, and patients were then classified into low- (zero), intermediate- (one) and high-risk (two to three) groups.

The TRES score was low in 41% of patients, intermediate in 37%, and high in 22%. Older age, male sex, Black race, Hispanic ethnicity, aggressive NHL subtype, no systemic therapy, and living in a census tract with lower income or high school graduation rates were all significantly associated with increased TRES scores.

The cause of death was reported and analyzed in 30,155 patients. The most common cause of death was NHL (23.6%; n=7,110). Compared to low risk, higher TRES scores were associated with increased lymphoma-specific mortality (LSM). In multivariable models of overall survival (OS), the hazard ratios were 1.10 (95% CI, 1.04-1.17) for intermediate- and 1.24 (95% CI, 1.17-1.33) for high-risk patients.

TRES score was significantly associated with LSM in the most common NHL subtypes. Three-year LSM rates were 6.4%, 8.1%, and 10% in CLL (P=.015); 31.2%, 37.8%, and 43.5% in large B-cell lymphoma (P<.001); and 8.8%, 14.2%, and 17.4% in follicular lymphoma (P<.001) with low, intermediate, and high TRES scores, respectively.

“The TRES comorbidity score is a simple to use tool which can be rapidly assessed and is associated with OS and LSM in older adults with NHL—median OS is more than five years shorter in patients with a high TRES score,” the investigators concluded. “Assessment of the TRES score should be incorporated into the care of older adults with NHL.”

Reference

Gordon M, Duan Z, Zhao H, et al. A novel, clinically adaptable comorbidity assessment tool for non-Hodgkin lymphoma (NHL), the three-factor risk estimate scale (TRES): analysis of 40,000 older adults enrolled in SEER-medicare. Abstract #794. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.