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A B S T R A C T S
S61
P042
SEGA (SHORT EMERGENCY GERIATRIC ASSESSMENT)
FRAILTY SCORE IN ELDERLY PATIENTS WITH
HAEMATOLOGICAL MALIGNANCIES
N. Carnel
1,
*, J. Poisson, T. Guerekobaya, P. Genet, A. Andreoli,
A. Al Jijakli, B. Poujol, L. Mesbah, L. Sutton, D. Chaoui
1
Haematology unit, Centre hospitalier Victor Dupouy, Argenteuil,
France
Introduction:
Long-termremission canbe achieved inelderly
patients with haematological malignancies. The challenge is
first to identify elderly patients illegible for a curative treatment
and second to prevent complications during the treatment.
In real life, haematological treatment decision does not
include Comprehensive Geriatric Assessment approach
mainly because of time-consuming. SEGA score is an easy tool
to detect frail patients admitted in emergency department.
Objectives:
We report here a real life experience of SEGA
score in elderly patients with haematological malignancies.
Methods:
This study was longitudinal, prospective and
mono-centric. We focused on patients aged 70 or older
who received their first cycle of chemotherapy between
September 1
st
2014 and August 31
th
2015. We recorded the
multidisciplinary treatment decision taken (curative or
palliative treatment). Geriatric tools recorded (G8 score,
CIRS score, sheet A SEGA score, ADL, IADL) were not used
during treatment decision. The first course of chemotherapy
was considered as the standard dose. We analysed during
the following chemotherapy courses: dose reduction,
chemotherapy delaying and early discontinuation. Analysis of
SEGA and other geriatric tools impact on treatment decision
(curative versus palliative), chemotherapy adaptation and
discontinuation was performed.
Results:
During the one year period analysis, 141 patients
70 years old (70-95) were discussed during our weekly
multidisciplinary meeting. Average age was 80. The most
frequent haematological diseases were distributed as follow:
NHL (32%), multiple myeloma (29%), CLL (13%) and MDS
(8%). Twenty one percent of patients and 18% were assigned
to Bendamustine and Bortezomib based chemotherapy,
respectively. Other chemotherapy regimens included (CHOP
and CHOP like treatment ± Rituximab (10%), 5-Azacytidine
(8%), IMID (8%). Palliative treatment decision was taken in
12 patients. At diagnosis, the mean sheet A SEGA score was
6,9 (1-21) indicating that the subjects included were mostly
not frail. CIRS mean total rate excluding haematological
malignancy was 6,19 (0-18).
CIRS score and SEGA score were significantly associated
with palliative treatment, p=0,045 and 0,002 respectively.
Regarding patients assigned to chemotherapy, treatment was
prematurely stopped in 34% of patients, dose reduction in
29% and chemotherapy was delayed in 17%. Only 20% did not
experience any of these events. CIRS grade 3 or 4 and CIRS
score
6 were strongly associated with early chemotherapy
discontinuation (p=0,014 and 0,0021, respectively). In contrast
no impact was observed regarding chemotherapy delaying
or dose reduction. SEGA score was not associated with early
discontinuation, nor dose reduction and chemotherapy
delaying.
Mainly reasons for early chemotherapy discontinuation
were: adverse events (60%) and disease progression (26%).
Conclusion:
SEGA score as well as CIRS could be helpful
in treatment choice. Palliative treatment could be the best
approach in patients with CIRS score
10 and or SEGA score
12. Patients CIRS score more than 6 are at higher risk of early
chemotherapy discontinuation. A special attention is required
for these patients to avoid such events.
Disclosure of interest:
None declared
Keywords:
CIRS, comorbidity, elderly, haematological
malignancy, SEGA
P043
A NEW FRAILTY SCORING IN “CLINICALLY FIT” OLDER
PATIENTS WITH MALIGNANT HEMOPATHIES ADMITTED TO
RECEIVE CHEMOTHERAPY
S. Dubruille
1,2
, C. Kenis
3
, Y. Libert
2
, M. Delforge
4
, J. Alexis Ruiz
1
,
M. Roos
5
, A. Collard
5
, N. Meuleman
1
, M. Maerevoet
1
, D. Razavi
2
,
H. Wildiers
3
, D. Bron
1,
*
1
Department of Hematology,
2
Clinic of Psycho-Oncology, Institut
Jules Bordet, Brussels,
3
Department of Oncology,
4
Department of
Hematology, University Hospitals Leuven, Leuven,
5
Onco-geriatry
Unit, Institut Jules Bordet, Brussels, Belgium
Introduction:
Patients“clinicallyfit”toreceivechemotherapy
suffering frommalignant hemopathies, are an heterogeneous
population covering fit and vulnerable patients. Patients
with geriatric syndromes and/or irreversible comorbidities
are usually excluded from high dose chemotherapy. We
recently reported that neither the G8 screening tool, nor the
CGA total score (
2 impairments) significantly predict overall
survival (OS) in this specific population of patients admitted
for chemotherapy (1). Regarding survival, in a multivariate
analysis, we found that only Mild Cognitive Impairment (MCI)
(MMSE<27 and/or MoCA<26) had a predictive value for one-
year OS [1]. However, a reliable “frailty score” remains urgently
needed to better define the vulnerable population that does
not benefit from chemotherapy.
Objectives:
To determine clinical and biological parameters
associated with unacceptable toxicity defined as 6 months
mortality in order to avoid overtreatment in these vulnerable
patients suffering from malignant hemopathies.
Methods:
This prospective multicentric study was
conducted in three departments of hematology in Belgian
Cancer Centers. A Comprehensive Geriatric Assessment (CGA)
was proposed to 251 consecutive patients (65-90yrs) with
malignant hemopathies admitted to receive chemotherapy.
Clinical data, biological parameters and causes of death were
extracted from medical records. Chi-square test and T-student
test were used to determine relationship between clinical data,
biological parameters and OS. Univariate and multivariate Cox
proportional hazards model were used to predict 6 months OS.
Results:
One hundred and twenty patients were evaluable
for all characteristics (NHL=40%, CLL=8%, MM=12%, AML=25%,
MDS=4%, others=11%). Fifty percent are males. Sixty percent
had a more favorable prognosis (CLL, Lymphoma or Multiple