title: Analysis of very elderly (≥80 years) non-hodgkin lymphoma: impact of functional status and co-morbidities on outcome.
abstract: Data on outcome, prognostic factors, and treatment for very elderly non-Hodgkin lymphomas (NHL) is sparse. We conducted a multicentre retrospective analysis of NHL patients ≥80 years (at diagnosis) treated between 1999 and 2009. Detailed characteristics were obtained including geriatric syndromes, activities of daily living (ADLs), and co-morbidities using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G). We identified 303 patients: 170 aggressive NHL (84% B cell/16% T cell) and 133 indolent NHL (82% B cell/18% T cell). Median age was 84 years (80-95). A geriatric syndrome was present in 26% of patients, 18% had ≥1 grade 4 CIRS-G, and 14% had loss of ADLs. At 49-month median follow-up, 4-year progression-free (PFS) and overall survival (OS) for aggressive NHLs were 31% and 44% respectively (stage I/II: PFS 53% and OS 66%; stage III/IV: PFS 20% and OS 32%; P < 0·0001 and 0·0002, respectively). Four-year PFS and OS for indolent NHL were 44% and 66% respectively, regardless of stage. Multivariate regression analysis identified two key factors that predicted inferior PFS and OS for both NHL groups: lack of CR and loss of ADLs. Prospective studies for very elderly NHL that incorporate geriatric tools, especially ADLs, are warranted.
authors.affiliation: Division of Hematology/Oncology, Advocate Lutheran General Hospital, 1700 Luther Lane, Park Ridge, IL, USA. cnabhan@oncmed.net
authors.forename: Chadi
authors.initials: C
authors.lastname: Nabhan
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
authors.forename: Irene
authors.initials: I
authors.lastname: Helenowski
authors.forename: Erika
authors.initials: E
authors.lastname: Ramsdale
authors.forename: Benjamin
authors.initials: B
authors.lastname: Parsons
authors.forename: Reem
authors.initials: R
authors.lastname: Karmali
authors.forename: Josephine
authors.initials: J
authors.lastname: Feliciano
authors.forename: Britt
authors.initials: B
authors.lastname: Hanson
authors.forename: Scott
authors.initials: S
authors.lastname: Smith
authors.forename: June
authors.initials: J
authors.lastname: McKoy
authors.forename: Annette
authors.initials: A
authors.lastname: Larsen
authors.forename: Andrew
authors.initials: A
authors.lastname: Hantel
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gregory
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Evens
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology* / Q000628:therapy*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome