Treatment and survival of NHL patients over the age of 80.

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Treatment and survival of non-Hodgkin lymphoma patients over the age of 80.

Meeting:2008 ASCO Annual Meeting

Abstract No:8569

Citation:J Clin Oncol 26: 2008 (May 20 suppl; abstr 8569)

Author(s):F. O. Nascimento, H. P. Soares, A. Ruiz, G. B. Weinberg, M. Cusnir

:Background: The incidence of Non-Hodgkin Lymphoma (NHL) has been increasing

by 1-2% annually; the rise is most dramatic in patients over 80, in whom the

rate rose 500% in the last 2 decades. Elderly are usually excluded from

clinical trials, and often from treatment; thus, optimal treatment for

elderly patients is unknown. The objective of this study was to review the

characteristics, management and outcomes of NHL patients older than 80 years

at diagnosis.

Methods: The records of all patients over age 80 diagnosed with NHL from

2000 to 2005 were reviewed. A total of 107 patients were found and

categorized as per the WHO classification. For statistical analysis, the

patients were divided into subgroups: (I) type of tumor (a. aggressive, b.

indolent), (II) international prognostic index (IPI) (1-2: low, 3-5: high),

and (III) chemotherapy protocol (a. standard, b. non-anthracycline, c. no

treatment). Overall survival rates were compared among subgroups of

patients. Results: Thirty patients (28%) received standard chemotherapy

(CHOP or CHOP-Rituximab). Forty-five (42%) received non-anthracycline

chemotherapy and 32 (30%) were not treated. Overall 1-year and 3-year

survival rates were 61.1±11.8% and 22.3±8.4%. The median survival time was

21±6 months. The indolent subgroup had better 1 and 3-year survival than the

aggressive subgroup (70.5% and 28% versus 47.1% and 9.1% respectively,

p=0.01). Similar results were seen in patients with low grade IPI when

compared with high grade IPI (62.2% and 43% versus 41% and 8.1%

respectively, p=0.002). The CHOP subgroup was compared with the

non-anthracycline and " no treatment " subgroups in the different subtypes. In

the aggressive subgroup, patients treated with CHOP had significantly longer

1-year and 3-year survival rates than those treated with non-anthracycline

(76% and 42% versus 35.8% and 17% respectively, p=0.014) or those receiving

no treatment (28.5% and zero, p=0.001).

Conclusions: Very elderly patients with aggressive NHL (large B-cell) have

significantly better survival rates at 1 and 3 years when treated with CHOP

or CHOP-R. Age alone should not be a contraindication to treatment.

Chemotherapy, howerver, did not affect outcome in patients with indolent

NHL.

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~ Karl