Non-Hodgkin's lymphoma in patients 70 years of age or older: factors associated with survival

Whom to treat? Factors associated with chemotherapy recommendations and outcomes among patients with NHL at the Uganda Cancer Institute

Introduction

Cancer treatment options in sub-Saharan Africa are scarce despite an increasing burden of disease. Identification of those cancer patients who would benefit most from the limited resources available would allow broader and more effective therapy.

Methods

We conducted a retrospective analysis of patients over the age of 18 at the time of a pathologic diagnosis of NHL between 2003 and 2010 who were residents of Kyandondo County (Uganda) and presented to the Uganda Cancer Institute for care.

Results

A total of 128 patients were included in this analysis. Chemotherapy was recommended to 117 (91.4%) of the patients; the odds of recommending chemotherapy decreased for each additional month of reported symptoms prior to diagnosis.

Of the 117 patients to whom chemotherapy was recommended, 111 (86.7%) patients received at least 1 cycle of chemotherapy; HIV infected patients, as well as those with a lower hemoglobin and advanced disease at the time of diagnosis were significantly less likely to complete therapy. Among the patients who initiated chemotherapy, twenty patients died prior to treatment completion (including nine who died within 30 days). Hemoglobin level at the time of presentation was the only variable associated with early mortality in the adjusted model.

Conclusion

In resource-poor areas, it is essential to align health care expenditures with interventions likely to provide benefit to affected populations. Targeting cancer therapy to those with a favorable chance of responding will not only save limited resources, but will also prevent harm in those patients unlikely to realize an effect of cancer-directed therapy.

Non-Hodgkin's lymphoma in patients 80 years of age or older

BACKGROUND

Very elderly patients (> or =80 years old) with non-Hodgkin's lymphoma (NHL) frequently have co-morbid conditions and are generally excluded from clinical trials or even from treatment. The optimal treatment of these patients is unknown.

PATIENTS AND METHODS

We reviewed the records of 109 patients > or =80 years at diagnosis of NHL (65 F/44 M; median age: 84 years, range; 80-95).

RESULTS

Seventy-eight patients (72%) had aggressive NHL, 25 (23%) had indolent and NHL, eight had unclassified disease. Advanced-stage disease was noted in 54%. Forty patients (39%) had a poor ECOG performance status (PS), and 52 (49%) had an intermediate or high risk International Prognostic Index (IPI). Seventy-nine patients (72%) were treated with chemotherapy and 37 (34%) with radiotherapy. Initial chemotherapy consisted of chlorambucil in 15, oral etoposide in 2, and combination protocol in 62. Only 16% of patients received full-dose therapy, and only 50% completed > or =6 cycles of combination chemotherapy. The overall response rate for the 69 evaluable patients was 84% (complete 56.5%, partial 27.5%). Overall 5-year survival for the whole group was 39%, and median survival time was 26 months.

CONCLUSION

A high response rate can be achieved in very elderly NHL patients despite aggressive histology, poor prognostic features, and reduced doses of chemotherapy. Age alone should not be a contraindication to treatment.

Non-Hodgkin lymphoma in elderly patients: experience at Taipei Veterans General Hospital

BACKGROUND

The annual incidence of non-Hodgkin lymphoma (NHL) has increased over the past two decades in all age groups, including the elderly. Establishing guidelines for proper care for this segment of the population requires further information.

METHODS

Between January 1993 and April 2002, 187 consecutive patients with NHL who were age 70 years or older were examined as part of the current study. Potential factors implicated in prognosis were analyzed for indolent lymphoma group and aggressive lymphoma group separately.

RESULTS

The median patient age was 75 years (range, 70-90 years), and 83% of the patients examined were male. Fifty-two patients (28%) had indolent lymphoma, and 135 patients (72%) had aggressive lymphoma. The complete remission rate was 33.3% for patients with indolent lymphoma and 35.9% for patients with aggressive lymphoma. Median overall survival was 41.5 months and 23.7 months for the indolent and aggressive lymphoma groups, respectively. The 1-year and 5-year survival rates were 76% and 32%, respectively, for patients with indolent lymphoma and 62% and 29%, respectively, for patients with aggressive lymphoma. Among patients with indolent lymphoma, poor prognosis was correlated with poor performance status (P = 0.0107), advanced disease stage (P = 0.0222), initial bone marrow involvement (P = 0.0069), and age greater than 80 years (P = 0.0486); however, none of these variables remained statistically significant after multivariate Cox regression. Among patients with aggressive lymphoma, the only prognostic factors that remained after multivariate analysis were performance status (P = 0.018) and age greater than 80 years (P = 0.029). For patients who received at least 2 courses of systemic chemotherapy, an anthracycline-containing regimen did not affect the survival rate in either the indolent lymphoma group (P = 0.81) or the aggressive lymphoma group (P = 0.34). After stratification, it was found that patients with aggressive lymphoma who were in the high-intermediate-risk group (as determined by International Prognostic Index [IPI] score) benefited most from the anthracycline-containing regimen (P = 0.0148).

CONCLUSIONS

Performance status was identified as the major prognostic determinant for elderly patients with aggressive NHL. In addition, it was found that an anthracycline-containing treatment regimen may be especially beneficial for patients in the high-intermediate-risk category as determined by IPI score.