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.
Bai
Li-Yuan
LY
Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Yang
Muh-Hwa
MH
Chiou
Tzeon-Jye
TJ
Liu
Jin-Hwang
JH
Yen
Chueh-Chuan
CC
Wang
Wei-Shu
WS
Hsiao
Liang-Tsai
LT
Chao
Ta-Chung
TC
Chen
Po-Min
PM
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D011379:Prognosis; D012044:Regression Analysis; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology