The Role of the Lawton Instrumental Activities of Daily Living (IADL) Scale in Predicting Adverse Events and Outcomes of R-CHOP Treatment in Elderly Patients with Diffuse Large B-Cell Lymphomas (DLBCLs) or Mantle Cell Lymphomas (MCLs): A Prospective Single-Center Study

Background: The prognostic value of the comprehensive geriatric assessment (CGA) is recognized by many in hematology. However, there is no consensus on the utilization of alternative abbreviated methods to assess disabilities in elderly patients with B-cell non-Hodgkin's lymphomas (B-NHLs).

Aim: The aim of this study was to prospectively analyze the prognostic value of selected CGA tools in predicting adverse events (AEs) and outcomes of R-CHOP or R-CHOP-like treatment in elderly patients with diffuse large B-cell lymphomas (DLBCLs) or mantle cell lymphomas (MCLs).

Methods: All patients who participated in this study underwent the Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Instrumental Activities of Daily Living (iADL) scale, the Vulnerable Elders Survey-13 (VES-13), the Groningen Frailty Index (GFI), and the Mini Nutritional Assessment Short Form (MNA-SF) before starting anticancer treatment. Selected clinical predictors were also included in the study.

Results: A total of 62 patients with newly diagnosed DLBCLs or MCLs, treated with R-CHOP in the Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation of Wroclaw University Hospital between 1 July 2018, and 1 July 2020, were included in the study. The median age upon initiation of the treatment was 72 years (range: 61-68). Multinomial logistic regression and Cox proportional hazard regression analysis demonstrated that the iADL scale was significantly associated with response to treatment (OR = 1.21, 95% CI: 1.02-1.44, p = 0.03), was inversely related to non-hematological AEs (OR = 0.81, 95% CI: 0.71-0.92, p = 0.001), and was a statistically significant predictor of longer overall survival (OS) (HR = 0.83, 95% CI: 0.79-0.89, p < 0.001) and longer progression-free survival (PFS) (HR = 0.91, 95% CI: 0.83-0.99, p = 0.03).

Conclusions: These results underscore the effectiveness of the iADL scale as a quick, easy-to-use, and universal CGA tool for evaluating crucial functional status before treatment in elderly hematological patients with DLBCLs or MCLs.