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Treatment and survival of non-Hodgkin lymphoma patients over the age of 8

2008; Lippincott Williams & Wilkins; Volume: 26; Issue: 15_suppl Linguagem: Inglês

10.1200/jco.2008.26.15_suppl.8569

1527-7755

Francisco O. Nascimento, Heloisa P. Soares, A. Ruiz, Gene B. Weinberg, Mike Cusnir,

Multiple and Secondary Primary Cancers

8569 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. No significant financial relationships to disclose.