A population-based study of transformed marginal zone lymphoma:identifying outcome-related characteristics

Histological transformation of marginal zone lymphoma (tMZL) into diffuse large B-cell lymphoma is associated with poor outcomes. Clinical characteristics associated with transformation risk and outcome after transformation are largely unknown due to scarcity of data. In this population-based study, competing risk analyses were performed to elucidate clinical characteristics associated with developing transformation among 1793 MZL patients using the Netherlands Cancer Registry. Cox regression analyses were performed to elucidate clinical characteristics associated with risk of relapse and mortality after transformation. Transformation occurred in 75 (4%) out of 1793 MZL patients. Elevated LDH and nodal MZL subtype at MZL diagnosis were associated with an increased risk, and radiotherapy with a reduced risk of developing tMZL. Most tMZL patients received R-(mini)CHOP (n = 53, 71%). Age &gt;60 years and (immuno)chemotherapy before transformation were associated with an increased risk of relapse and mortality after transformation. Two-year progression-free survival (PFS) and overall survival (OS) were 66% (95% CI 52-77%) and 75% (95% CI 62-85%) for R-(mini)CHOP-treated tMZL patients, as compared to a PFS and OS both of 41% (95% CI 19-63%) for patients treated otherwise. Our study offers comprehensive insights into characteristics associated with transformation and survival after transformation, thereby optimizing guidelines and patient counseling.</p

PROBLEMEN MET PREVENTIEVE MEDICATIE BIJ HOOGBEJAARDE PATIËNTEN MET MULTIMORBIDITEIT: Een vragenlijstonderzoek bij eerstelijns zorgverleners

Introduction: The effects of preventive medication in elderly are not well known. Qualitative research indicates that healthcare providers experience problems in managing preventive medication in the very elderly with multimorbidity. To this date no questionnaire is developed to quantify these results. Aim and research question: We want to determine the attitudes and policies of primary healthcare providers about discontinuation of preventive medication in geriatric patients with multimorbidity. The aim of this research is to develop a questionnaire and to obtain first insights into the views of primary healthcare providers. Methods: Based on qualitative research and literature a questionnaire was developed and presented to GPs and practice nurses. In three rounds, a list of 40 questions was developed and validated, including questions on the balance between treatment goals, goals of care, time until benefit, life expectancy and the use of clinical guidelines. Results: A total of 25 GPs and 12 practice nurses responded. Many healthcare providers experience problems with preventive medication in the very elderly patients with multimorbidity. Many GPs consider the NHG-standards not applicable for these patients. In adjusting the guidelines to these patients three groups of caregivers seem to exist: those who find the considerations from a patient perspective most important, those who find the medical-biological considerations most important and a minority who weighs the considerations from a patient perspective and medical-biological considerations equally. On many points the caregivers agree, but there are also differences. Practice nurses take the increased risk of side effects less into account, but are more involved in shared decision making than GP’s and feel less incompetent in this field. Discussion and conclusions: With some adjustments, the developed questionnaire is a good and valid measuring instrument. Although these are preliminary results of a small study, we found clear patterns in points of view. Healthcare providers require tools to handle medication problems in elderly patients. More scientific evidence about the actual effects of treatments in the very elderly with multimorbidity and an improvement in communication skills will enhance safe, effective and individualized prescribing of medication.