Comprehensive Geriatric Assessment to Predict Toxic Events in Older Patients With Non-Hodgkin Lymphoma With Imbedded Pilot Study of Pre-Phase Therapy

Inclusion criteria

Subjects meeting the following criteria will be eligible for enrollment in the study (unless excluded):

• ≥60 years old
• Pathologically confirmed NHL.
• Must meet criteria for initiation of treatment; consisting of:
• Aggressive histology, or
• Indolent histology with one of the following markers of large tumor burden (67):
• Any nodal or extranodal tumor mass ≥7cm in greatest dimension
• ≥3 nodal masses that are each ≥3 cm in greatest dimension
• Systemic symptoms
• Cytopenias (leukocytes <1 × 109/L and/or platelets ,100 × 109/L)
• Substantial splenomegaly
• Serous effusion (plural effusion or peritoneal ascites)
• Orbital or epidural involvement
• Ureteral compression
• Leukemic phase (malignant cells ≥5 x 109/L)
• Must be starting a new chemotherapy regimen (patients whose treatment regimen includes an immunomodulatory agent such as lenalidomide or small molecule targeted agents such as Ibrutinib or Idelelasib will be included in the study; patients being treated with a single agent monoclonal antibody will not be included).
• Fluent in English (because not all components of the GA have been validated in other languages)
• Able to provide informed consent

In addition to the above, subjects meeting the following criteria will be enrolled in the pre-phase arm of the study, until the accrual target for that arm is reached:

• Age ≥ 70 years OR KPS ≤ 70
• Pathologically confirmed diagnosis of DLBCL, with or without simultaneous or antecedent indolent lymphoma.
• Previously untreated for DLBCL
• Intended initial treatment to include ≥2 cycles of R-CHOP, R-EPOCH or R-CEPP using standard doses and schedule.(68, 69) R-CHOP chemoimmunotherapy may be given every 14 days or every 21 days. (4, 70)

Exclusion criteria

Subjects meeting the following criteria will be excluded from enrollment in the study:

• Enrollment in a Phase I trial
• Previously enrollment in this study
• Patients scoring ≥ 11 on the BOMC (implying cognitive impairment) will be excluded since their ability to reliably complete the questionnaire will be in doubt Subjects meeting the following criteria will be excluded from enrollment in the pre-phase arm of the study, but may be included in the GA only arm.
• Contraindication to use of rituximab or prednisone including:
• Uncontrolled diabetes mellitus
• Systemic fungal infection
• Evidence of active hepatitis B infection (i.e. patients testing positive hepatitis B surface antigen or viral DNA by PCR analysis) will be excluded. Patients with evidence of past infection without active viremia (i.e. positive hepatitis B core antibody, negative hepatitis B surface antigen and negative hepatitis B DNA PCR) will be treated with entecavir as per institutional guidelines and may be included in the study.
• History of any serious adverse reaction to either a corticosteroid or rituximab not including rituximab infusion reactions ≤ Grade 3.
• Patients enrolled on another clinical trial which prohibits the use of pre-phase therapy or any of its components.