A novel comorbidity score for older adults with non-Hodgkin lymphoma: the 3-factor risk estimate scale.

In patients with non-Hodgkin lymphoma (NHL), formal comorbidity assessment is recommended but is rarely done in routine practice. A simple, validated measure of comorbidities that standardized their assessment could improve adherence to guidelines. We previously constructed the three-factor risk estimate scale (TRES) in patients with chronic lymphocytic leukemia (CLL). Here, we investigated TRES in multiple NHL subtypes. Patients in the SEER-Medicare database with NHL diagnosed during 2008-2017 were included. Upper gastrointestinal, endocrine, and vascular comorbidities were identified using ICD-9/ICD-10 codes to assign TRES score. Patient characteristic distributions were compared by chi-square or t-test. Association of mortality and TRES score was assessed by Kaplan-Meier and multivariable Cox regression with competing risk. 40,486 patients were included. Median age was 77 years (interquartile range [IQR] 71-83 years). The most frequent NHL subtypes were CLL (28.2%), diffuse large B-cell (27.6%) and follicular lymphoma (12.6%). Median follow up was 33 months (IQR, 13-60 months). TRES was low, intermediate and high in 40.8%, 37.0% and 22.2% of patients, corresponding to median overall survival (OS) of 8.2, 5.3 and 2.9 years (P<0.001). TRES was associated with OS in all NHL subtypes. In multivariable models TRES was associated with inferior OS and NHL-specific survival (HR, 1.27 [95%CI 1.23-1.31] and HR, 1.10, [95%CI 1.04-1.16] for intermediate vs. low; HR, 1.67 [95%CI 1.61-1.74] and HR, 1.23, [95%CI 1.15-1.31] for high vs. low). TRES is clinically translatable and associated with OS and lymphoma-specific survival in older adults with NHL.