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Comorbidity burden and prognosis in patients aged 80+ years with large B-cell lymphoma
Journal article   Peer reviewed

Comorbidity burden and prognosis in patients aged 80+ years with large B-cell lymphoma

Prokop Vodička, Michal Masár, Carrie A. Thompson, David Belada, George A. Cholack, Kateřina Benešová, Izidore S. Lossos, Heidi Móciková, Diana Maláriková, AnnaLynn M. Williams, …
Clinical lymphoma, myeloma and leukemia
09/23/2026
DOI: 10.1016/j.clml.2026.09.015
PMCID: PMC13689689
PMID: 42881024

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Abstract

Background Patients aged 80+ years with large B-cell lymphoma (LBCL) represent a rapidly growing and vulnerable population where conventional prognostic indices inadequately capture comorbidity burden. We evaluated prognostic value of the LEO Comorbidity Index (LCI) and derived simplified comorbidity model in this setting. Methods In a pooled cohort of 539 patients aged 80+ years with LBCL from two independent international cohorts, we evaluated associations between comorbidities/LCI (based on ten comorbidity categories) and OS or EFS. Model discrimination and fit were assessed using C-indices and likelihood ratio tests. Results LCI categories were 0 (19%), 1 (31%), 2+ (50%). Higher LCI predicted inferior OS (LCI 1 vs 0: HR=1.43 [95% CI 1.04-1.97]; LCI 2+ vs 0: HR=1.88 [1.40-2.53]), EFS (LCI 1 vs 0: HR=1.37 [1.00-1.87]; LCI 2+ vs 0: HR=1.78 [1.33-2.38]), and higher non-lymphoma mortality (2-year, LCI=0 11%, LCI=1 13%, LCI 2+ 26%). Heart disease (48%), prior or concurrent malignancy (9%), and stroke (8%) independently predicted OS, and were combined into the MaSH-CI (Malignancy, Stroke, Heart disease; one point each), stratifying patients into scores 0 (44%), 1 (47%), and 2+ (9%). Higher MaSH-CI predicted inferior OS (MaSH-CI 1 vs 0: HR=1.59 [1.27-1.98]; MaSH-CI 2+ vs 0: HR=2.43 [1.70-3.47]). Adding LCI or MaSH-CI to IPI/SENIOR-IPI significantly improved model fit and discrimination across all endpoints (ΔC-index 0.02–0.03). Conclusion Multi-morbidity is a strong predictor of outcomes in LBCL patients aged 80+ years. The simplified MaSH-CI provides additive prognostic value beyond conventional prognostic indices and offers a practical tool for risk-adapted management in this population. [Display omitted]
 comorbidities frailty Large B-cell lymphoma octogenarians

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