Malignant lymphomas in the elderly: A single institute experience highlights future directions (original) (raw)
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Treatment of Non-Hodgkin's Lymphomas in Elderly Patients
Clinical Lymphoma, 2004
The roles of evolving treatment strategies for non-Hodgkin's lymphomas (NHL) in elderly patients are still not well defined and their effects on the overall epidemiology of the disease are still not clear. Three questions arise when discussing the management of NHL in elderly patients. First, should older patients be treated with the same regimens usually administered to younger patients? Second, are health outcomes of elderly patients similar to those usually observed in young patients, particularly response rate and overall survival? Third, which strategies should be adopted to improve overall health outcomes? Periodic review of the literature and updated data on the management of NHL in elderly patients may provide an answer to all these queries. In essence, older patients must be treated with the same intensive approaches that are usually reserved for younger patients. The results reported in randomized controlled clinical trials are consistent with the capability of older patients to exhibit overall response rate, event-free survival, and overall survival similar to those observed in their younger counterparts. Combining chemotherapy and monoclonal antibodies seems to be the main optional strategy for better outcomes in elderly patients. In contrast, knowledge concerning the management of indolent lymphomas in elderly patients is still lacking, and available clinical data are limited in this setting, especially in patients with poor prognostic factors who may need an immediate therapeutic intervention.
Annals of Oncology, 2013
Background: Lymphoma occurring in patients aged 90 or older is not uncommon, and its incidence is expected to increase over time. Management of these patients is difficult given their underlying fragility and the lack of information regarding this population. Patients and methods: We retrospectively analyzed 234 patients diagnosed with lymphoma at the age of 90 years or older (90+) between 1990 and 2012 to describe their characteristics, management, outcomes and prognostic factors. Results: The median age was 92 years; 88% were B-cell lymphomas consisting mainly in diffuse large B-cell lymphoma. The median overall survival (OS) was 7.2 months (range, 0-92 months) for the 227 patients with non-Hodgkin Lymphoma (NHL), with a significant difference between aggressive and indolent NHL (5.2 months versus 19.4 months, respectively). We further analyzed 166 NHL patients for whom detailed characteristics were available. Among these patients, 63.5% received a treatment, either local (7.5%) or systemic (56%). Lymphoma was reported as the main cause of death (40%). Treatment administration was associated with improved OS in patients with aggressive (P < 0.001) but not indolent NHL (P = 0.96). In patients with aggressive NHL, hypoalbuminemia appeared as a strong and independent negative prognostic factor. Conclusions: The median OS is short in 90+ patients diagnosed with lymphoma but some patients experience prolonged survival. Lymphoma represents the main cause of death in these patients. Treatment may improve survival of selected patients with aggressive but not indolent NHL. Management of these patients may be guided by prognostic factors identified in this study, notably serum albumin.
Treatment of aggressive Non-Hodgkin's lymphoma in the elderly
American Journal of Hematology, 1995
A nonanthracycline-containing chemotherapeutic combination for the treatment of intermediate and high-grade nonHodgkin's lymphoma was evaluated. Thirty-four consecutive and previously untreated patients, with a median age of 75 (range 54-86) years, with aggressive lymphoma, received daily etoposide (60 mg/m2 intravenous infusion [Wl]), cytosine arabinoside (50 mg/m2 subcutaneously), and methylprednisolone (60 mg/m2 IVI) on each of 5 consecutive days. Individuals with limited disease (stages I and II) (n = 9) received six, 3-day cycles of the same therapy and involved field radiation (36 Gy in 20 fractions) between the third and fourth courses. Patients with disseminated lymphoma (n = 25) received 10 cycles over 8 months of the same combination, with the addition of methotrexate (200 mg/m2 on days 8 and 15), followed by leucovorin rescue (10 mg/m2 orally every 6 hr for 8 doses).
Treatment modalities of non-Hodgkin lymphoma patients over 65 years of age: A two-center experience
Journal of Oncology Pharmacy Practice, 2019
This study was conducted with the aim of making the contribution to a decision for treatment and determination of the modalities in patients diagnosed with non-Hodgkın lymphoma which increasingly become widespread in the geriatric population. Materials and methods: Ninety-one patients aged over 65 years diagnosed with lymphoma and treated in Bezmialem Vakıf University Medical Faculty Hospital and Haseki Training and Research Hospital between 2008 and 2013 were retrospectively evaluated. Finally, 63 patients for whom data could be reached were included in the study. Results: Examining the results, histological diagnoses of our patients were as follows: diffuse large B-cell lymphoma (50.8%), follicular lymphoma (23.8%), marginal zone lymphoma (12.7%), mantle cell lymphoma (4.8%), T-cell lymphoma (4.8%), lymphoplasmacytic lymphoma (1.6%) and small lymphocytic lymphoma (1.6%). Stages at the time of diagnosis were early stage by 33.3% and late stage by 66.7%. Of the patients, 36.5% had a low-intermediate and 63.5% a highintermediate International Prognostic Index score. According to the Eastern Cooperative Oncology Group scoring, 34.9% of the patients have an Eastern Cooperative Oncology Group score of 2-4. Activities of daily living score of 33.3% patients was under 5. Looking at the responses to treatment, the complete response was found in 50.8%, partial response in 4.8%, stable disease in 1.6% and progressive disease in 9.5% of the patients. The mean follow-up duration of patients was found as 25.2 months and disease-free survival after remission as 20.2 months. Conclusion: We found that we have achieved a complete remission in more than half of our patients (50.8%). Based on this, treatment should aim remission in elderly patients.
Non-Hodgkin's lymphoma in patients 80 years of age or older
Annals of Oncology, 2006
Background: Very elderly patients ( ‡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.
Biological and clinical features of non-Hodgkin's lymphoma in the elderly
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
The incidence of non-Hodgkin's lymphomas (NHLs) in elderly people has increased in recent years because the world population is getting older. The aim of this study was to compare the biological and clinical features in patients diagnosed with NHLs younger and older than 65 years, and the possible influence of age on the choice of optimal therapeutic approach. We retrospectively evaluated 193 patients with NHLs: 111 (68%) were <65 years and 82 (42%) ≥65 years. The following parameters were analysed: age, gender, clinical stage, International Prognostic Index (IPI), histological type, presence of B symptoms, disease localization, presence of bulky mass, Karnofsky performance status (PS), comorbidities, blood counts, liver and renal function and serum LDH. Elderly patients had statistically more frequent indolent NHLs (p=0.036), IPI 3 and 4 (p<0.0001), presence of comorbidities (p<0.001), and less frequent presence of bulky disease (p7equals;0.043). Response to therapy wa...
The Treatment of Elderly Patients with Aggressive Non-Hodgkin’s Lymphoma
Cytotherapy, 2005
The treatment of elderly patients with an aggressive non-Hodgkin’s lymphoma has gradually changed over the last decades. The first publications concerning elderly patients with lymphoma emphasized the increased toxicity and poor outcome of this patient group.(1-3) The aim of many subsequent studies has been to decrease toxicity.(4-6) Most of these studies however reported decreased response rates and deterioration of survival if age adapted therapy was used. It also became evident that doxorubicin proved to be a toxic, but essential drug in any regimen prescribed with a curative intention.(7-9) The development of recombinant granulocyte colony-stimulating factor (G-CSF) raised expectations that this growth factor could improve the results of therapy because it would become possible to maintain the dose-intensity of the chemotherapy regimen by inducing rapid hematopoietic recovery.(10) Moreover, a shorter duration of the neutropenic phase could probably reduce the incidence of neutro...
Cancer, 2000
There is no consistent definition at what age patients with non-Hodgkin lymphoma (NHL) are considered "elderly." This might hamper well balanced decisions with respect to treatment. From a population-based NHL registry the age groups younger than 60 years, 60-64 years, 65-69 years, 70-74 years, and 75 years and older were analyzed in relation to the revised European-American lymphoma classification and to the age-adjusted International Prognostic Index (IPI). The prognostic value of the variables from the age-adjusted IPI was determined. The relative survival probabilities were calculated. The incidence of diffuse large B-cell lymphoma (DLBL) increased with advancing age, as was the case for small lymphocytic lymphomas. Follicular lymphomas were less frequently encountered with advancing age. With respect to the so-called indolent lymphomas, a decreasing complete remission rate and overall survival rate (5-year) was observed for patients older than 70 years, whereas patients with DLBL fared worse when older than 65 years and 60 years, respectively. The age-adjusted IPI score was discriminative for prognosis. However, even with an IPI score nil, the age group older than 75 years fared significantly worse (P < 0.009), but less so with the relative survival model. The relative survival at 5 years was 60%, 53%, 48%, 35%, and 32% for the 5 respective age groups. Patients with indolent lymphomas become elderly when they are older than 70 years, but when aggressive lymphoma is concerned this occurs when patients are older than 65 years. For patients with an IPI score nil, age older than 75 years is the dominant prognostic factor. The negative influence of concomitant disease on overall survival, although continuously increasing in older age groups, seems to diminish for patients older than 75 years when compared with the general Dutch population.
European Journal of Cancer, 2006
This population-based study investigates the use of chemotherapy and radiotherapy for non-Hodgkin&amp;amp;amp;amp;amp;amp;amp;#39;s lymphoma (NHL) treatment in clinical practise generally, and for specific histologies, and identifies factors associated with treatment and survival. Data for NHL patients, diagnosed during 1999-2001, were obtained from the National Cancer Registry (Ireland). Multivariate models were analysed on survival and treatment. 45-77% of patients received chemotherapy, 22-34% of patients received the radiotherapy, depending on the histology. Patients aged &amp;amp;amp;amp;amp;amp;amp;lt;65, married, with early stage B-cell aggressive disease were more likely to receive chemotherapy (P&amp;amp;amp;amp;amp;amp;amp;lt;0.05). Patients &amp;amp;amp;amp;amp;amp;amp;gt;65 or with advanced stage were less likely to receive radiation (P&amp;amp;amp;amp;amp;amp;amp;lt;0.05). Survival was poorer in older (P&amp;amp;amp;amp;amp;amp;amp;lt;0.001) and unmarried patients (P&amp;amp;amp;amp;amp;amp;amp;lt;0.05), and those with B-cell aggressive lymphoma (P&amp;amp;amp;amp;amp;amp;amp;lt;0.001). Patients who received chemotherapy and radiation had lower hazard ratios. Overall, the use of chemotherapy and radiation in this European population was similar to the findings in the US where older patients received treatment less often. However, the age disparity here was greater than that in the US.