Orlandi E, Lazzarino M, Brusamolino E, Castelli G, Pagnucco G, Morra E, Bernasconi C
Cattedra di Ematologia, Università di Pavia, Italy.
Haematologica. 1991 May-Jun;76(3):204-8.
Treatment of older patients with non-Hodgkin's lymphoma (NHL) is difficult and conflicting. Lower responsiveness to therapy has been reported; however, the high risk of treatment morbidity, drug-dose reduction, and the occurrence of unrelated deaths might account for the poor outcome of NHL in the elderly.
We retrospectively analyzed the therapeutic approach and the outcome in 90 NHL patients aged 65 years or older. Histologic classification was according to the Working Formulation.
Twenty-nine patients with low-grade NHL have been managed conventionally: complete response (CR) rate was 34.5% and median overall survival was 35 months. Sixty-one patients with intermediate-grade (IG, 36 cases) or high-grade (HG, 25 cases) NHL were treated as follows: 5 stage I-IE cases underwent radiation therapy; of 56 stage II-IV patients, 14 had conservative single-agent therapy and 32 received an attenuated CVP regimen. Only 10 patients were considered suitable for attenuated CHOP or CHOP-like programs. Overall CR rate was 50% for IG and 32% for HG NHL: Median survival was 33 months and 10 months (p less than or equal to 0.05), respectively. For IG and HG patients, the attainment of CR influenced survival significantly. Treatment morbidity was observed in 41% of patients. Resistant lymphoma was the major cause of death (31/36) during the first six months of therapy.
In our experience, the outcome of elderly NHL patients treated with conservative therapeutic approaches is poor. Intensive chemotherapy regimens tailored to individual patients are needed to improve clinical results.
老年非霍奇金淋巴瘤（NHL）患者的治疗困难且存在争议。已有报道称其对治疗的反应性较低；然而，治疗相关并发症的高风险、药物剂量的减少以及非相关死亡的发生可能是老年NHL患者预后不良的原因。
我们回顾性分析了90例65岁及以上NHL患者的治疗方法和预后。组织学分类依据工作分类法。
29例低度NHL患者采用传统方法治疗：完全缓解（CR）率为34.5%，中位总生存期为35个月。61例中度（IG，36例）或高度（HG，25例）NHL患者的治疗如下：5例I - IE期患者接受放射治疗；56例II - IV期患者中，14例接受保守单药治疗，32例接受减量CVP方案治疗。仅10例患者被认为适合减量CHOP或类似CHOP方案。IG NHL和HG NHL的总体CR率分别为50%和32%：中位生存期分别为33个月和10个月（p≤0.05）。对于IG和HG患者，达到CR对生存期有显著影响。41%的患者出现治疗相关并发症。难治性淋巴瘤是治疗前六个月内死亡的主要原因（31/36）。
根据我们的经验，采用保守治疗方法的老年NHL患者预后较差。需要针对个体患者制定强化化疗方案以改善临床结果。
