The Significance and Predictive Performance of Gait Speed and Grip Strength in Frailty Assessment of Newly Diagnosed DLBCL

Introduction

The Lymphoma Italian Foundation-Comprehensive Geriatric Assessment (FIL-CGA) is a validated tool used to prospectively identify frail individuals among elderly patients with diffuse large B-cell lymphoma (DLBCL). It includes factors such as age, activities of daily living (ADL), instrumental ADL (IADL), and a modified cumulative illness rating score for geriatrics (MCIRS-G). This assessment helps identify elderly, non-fit patients who may not benefit from curative treatment as much as from palliative care, and it also analyzes potential benefits of treatment modulation by further subdividing the non-fit category according to CGA criteria. The FIL-CGA has proven effective in identifying elderly patients suitable for standard-dose R-CHOP regimen therapy. However, its time-consuming nature and subjectivity limit its widespread clinical use. Gait speed and grip strength are objective and easily obtainable measures of physical function. Our analysis aimed to explore their potential value as alternative frailty assessment tools for older patients with DLBCL.

Methods

All 26 patients aged 60 years and older, diagnosed with DLBCL at the Affiliated Hospital of Hebei University between 1 October 2022 and 31 May 2024, were eligible for participation. The study was approved by the Ethics Committee of Hebei University Affiliated Hospital. Gait speed was measured using the National Institutes of Health 4-meter gait speed test. Participants were asked to walk at a usual pace for 4 meters from a standing start, with the speed recorded in meters per second (m/s) using a stopwatch. Grip strength was measured using a digital dynamometer, with each hand tested once; the strength (in kilograms) of the dominant hand was used in this study. All enrolled patients underwent FIL-CGA frailty assessment, gait speed, and grip strength measurement before developing a therapeutic schedule, during mid-term treatment (C4), and after treatment (C8).

Results

At baseline, patients with DLBCL were grouped according to FIL-CGA into fit (58%), unfit (27%), and frail (15%). At C4, these proportions changed to fit (69%), unfit (24%), and frail (7%). At C8, they were fit (78%), unfit (14%), and frail (8%).

For gait speed, the proportions of patients with <0.8 m/s were 39%, 28%, and 17% at the three different dynamic evaluation points, respectively, while those with ≥0.8 m/s were 61%, 72%, and 83%. The proportion of patients with grip strength below the standard was 53%, 51%, and 52%, respectively, and above the standard were 47%, 49%, and 48%.

At baseline, both gait speed and grip strength showed consistency with FIL-CGA, with AUC values of 0.815 and 0.774, respectively. Dynamic analysis revealed that at C4, the AUC values for gait speed and grip strength were 0.708 and 0.689, and at C8, they were 0.772 and 0.806.

Conclusions

For DLBCL patients, the frailty state is dynamic and changes over time. At the end of the treatment, the frailty state achieved maximum improvement. Gait speed shows good consistency with FIL-CGA and may serve as a readily available and easy-to-implement frailty screening tool in routine clinical assessment. Grip strength may be useful for patients who cannot perform the gait speed test. However, further research is needed, including expanding the sample size and extending the follow-up period.

No relevant conflicts of interest to declare.