Non-Hodgkin's lymphoma in the elderly: the impact of advanced age on therapeutic options and clinical results.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.