title: Lymphoma occurring in patients over 90 years of age: characteristics, outcomes, and prognostic factors. A retrospective analysis of 234 cases from the LYSA.
abstract: 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.
  
  
  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.
authors: Department of Hematology, Centre Hospitalier Universitaire de Rennes, INSERM U917, Rennes.
authors: A
authors: A
authors: Trebouet
authors: Department of Hematology, Centre Hospitalier Universitaire de Rennes, INSERM U917, Rennes.
authors: T
authors: T
authors: Marchand
authors: Department of Hematology, Centre Hospitalier Universitaire de Clermont-Ferrand Hôpital Estaing, Université d'Auvergne CREaT - EA 7283, Inserm CIC-501, Clermont-Ferrand.
authors: R
authors: R
authors: Lemal
authors: Department of Hematology, Centre Hospitalier Universitaire de Tours, CIC INSERM U202, Tours.
authors: E
authors: E
authors: Gyan
authors: Department of Hematology, Institut Paoli Calmettes, Marseille.
authors: F
authors: F
authors: Broussais-Guillaumot
authors: Department of Hematology, Centre Léon Bérard, Université Lyon 1, Lyon.
authors: Y
authors: Y
authors: Guillermin
authors: Department of Hematology, AP-HP, Hôpital Saint Louis, Université Paris 7, INSERM U728, Paris.
authors: H
authors: H
authors: Monjanel
authors: Department of Hematology, Hospices Civils de Lyon, Université Lyon-1, Pierre-Bénite.
authors: G
authors: G
authors: Salles
authors: Department of Hematology, Centre Hospitalier Universitaire de Nantes, Nantes.
authors: S
authors: S
authors: Le Gouill
authors: Department of Hematology, Centre Hospitalier de Bretagne Atlantique, Vannes.
authors: P
authors: P
authors: Godmer
authors: Department of Hematology, Centre de lutte contre le Cancer François Baclesse, Caen.
authors: C
authors: C
authors: Fruchart
authors: Department of Hematology, Centre Hospitalier Universitaire d'Amiens, Amiens.
authors: G
authors: G
authors: Damaj
authors: Department of Hematology, Centre Hospitalier Universitaire de Nancy, Nancy.
authors: P
authors: P
authors: Feugier
authors: Department of Hematology, AP-HP, Hôpital Saint Louis, Université Paris 7, INSERM U728, Paris.
authors: C
authors: C
authors: Thieblemont
authors: Hematological Cancer Registry of Côte d'Or, UCOG de Bourgogne, EA4184, Université de Bourgogne, Dijon.
authors: M
authors: M
authors: Maynadié
authors: Hematological Cancer Registry of Gironde, Institut Bergonié, Bordeaux.
authors: A
authors: A
authors: Monnereau
authors: Hematological Cancer Registry of Basse Normandie, Centre Hospitalier Universitaire de Caen, Caen.
authors: X
authors: X
authors: Troussard
authors: Department of Biology, Centre Hospitalier Universitaire de Rennes, Rennes, France.
authors: D
authors: D
authors: Rossille
authors: Department of Hematology, Centre Hospitalier Universitaire de Rennes, INSERM U917, Rennes.
authors: T
authors: T
authors: Lamy
authors: Department of Hematology, Centre Hospitalier Universitaire de Rennes, INSERM U917, Rennes. Electronic address: Roch.HOUOT@chu-rennes.fr.
authors: R
authors: R
authors: Houot
mesh_terms: D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013534:Survival
chemical_list: D012709:Serum Albumin
keywords: aged 80 and over; comorbidity; lymphoma; palliative care