Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group, Nanjing, China.
Cancer Med. 2024 Aug;13(16):e70178. doi: 10.1002/cam4.70178.
Lymphoma is the most common secondary cause of hemophagocytic lymphohistiocytosis (HLH) in adults. Lymphoma-associated HLH (LA-HLH) in the elderly population is not rare, however, little has been reported regarding clinicopathological characteristics, prognostic factors, and outcomes of LA-HLH in the elderly population.
We retrospectively analyzed a multicenter cohort of elderly patients with LA-HLH. Clinicopathological features and treatment information were collected. The impacts of baseline characteristics and treatments on survival outcomes were analyzed.
A total of 173 elderly patients with LA-HLH were included. Compared with young patients, elderly patients showed different clinical and laboratory features. Regarding lymphoma subtypes, B-cell lymphoma was more common in elderly patients (elderly 61.3% vs. young 32.3%, p < 0.001) while T/NK-cell lymphoma was more common in young patients (65.3% vs. 35.3%, p < 0.001). The median survival of elderly patients with LA-HLH was only 92 days. The prior use of HLH therapy or etoposide-containing HLH therapy was not associated with improved overall survival. T/NK-cell subtype, a lower platelet count (≤53 × 10/L), a lower albumin level (≤32.1 g/L), a higher LDH level (>1407 U/L), and a higher creatinine level (>96.8 μmol/L) were independent predictors of decreased overall survival and 60-day survival. A prognostic index was established and demonstrated to be robust in predicting the overall survival and 60-day survival of elderly patients with LA-HLH.
LA-HLH in elderly patients displayed heterogeneous clinicopathological features and survival outcomes. Treatments need to be optimized to improve the outcomes of elderly patients with LA-HLH.
淋巴瘤是成人噬血细胞性淋巴组织细胞增生症（HLH）最常见的继发性原因。老年人中与淋巴瘤相关的 HLH（LA-HLH）并不罕见，但关于老年人中 LA-HLH 的临床病理特征、预后因素和结局的报道很少。
我们回顾性分析了一组多中心老年 LA-HLH 患者队列。收集了临床病理特征和治疗信息。分析了基线特征和治疗对生存结局的影响。
共纳入 173 例老年 LA-HLH 患者。与年轻患者相比，老年患者表现出不同的临床和实验室特征。在淋巴瘤亚型方面，老年患者中 B 细胞淋巴瘤更为常见（老年患者 61.3%，年轻患者 32.3%，p<0.001），而年轻患者中 T/NK 细胞淋巴瘤更为常见（老年患者 65.3%，年轻患者 35.3%，p<0.001）。老年 LA-HLH 患者的中位生存时间仅为 92 天。既往使用 HLH 治疗或含依托泊苷的 HLH 治疗与总生存改善无关。T/NK 细胞亚型、血小板计数较低（≤53×10/L）、白蛋白水平较低（≤32.1g/L）、乳酸脱氢酶水平较高（>1407U/L）和肌酐水平较高（>96.8μmol/L）是总生存和 60 天生存降低的独立预测因素。建立了一个预后指数，该指数在预测老年 LA-HLH 患者的总生存和 60 天生存方面表现稳健。
老年患者的 LA-HLH 表现出异质性的临床病理特征和生存结局。需要优化治疗以改善老年 LA-HLH 患者的结局。
