EFFECT OF AGE ON CHARACTERISTICS AND CLINICAL BEHAVIOR OF ADULT AGRESSIVE NON-HODGKIN'S LYMPHOMA

Year 2006, Volume: 3 Issue: 3, 93 - 101, 01.09.2006

Suleyman Alıcı Sevil E Bavbek Mert Başaran Haluk Onat

Abstract

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Keywords

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EFFECT OF AGE ON CHARACTERISTICS AND CLINICAL BEHAVIOR OF ADULT AGRESSIVE NON-HODGKIN'S LYMPHOMA

Abstract

Aim: The importance of age as a prognostic factor in aggressive non-Hodgkin\'s lymphoma (NHL) remains controversial. It is not clear whether age is an independent factor or reflecting the limited physiologic reserves of the patients. Methods: We retrospectively analyzed prognostic factors according to age (≤60/>60) in 201 patients with aggressive NHL treated at our institution between 1989 and 1998 years. An ageadjusted prognostic index was used for younger and older than 60 years patients with aggressive NHL in order to give 5 years survival analysis. Results: Seventy-four (37%) of the patients were older than 60 years and 40 of these were male (54%). Older patients presented with more advanced disease than younger patients (p=0.01). Median follow-up in younger and older patients were 37.6 (range 1-120), and 20.8 (range 1-58) months, respectively. Median survival in younger and older patients were 75 months and 29 months, respectively (p=0.0001). Five years overall survivals rates in younger and older patients were 52% and 40%, respectively (p=0.036). There were significant differences in the median survival according to prognostic factors [sex, performance status (PS), B symptoms, stage, bulky disease, extra-nodal involvement site (ENI), histologic grade, response to treatment, serum lactate dehydrogenase (LDH), β2-microglobulin and albumin levels)] between the two age groups in univariate analyses (p=0.001). In the multivariate analyses response to treatment (complete response and not complete response) (p=0.005), and performance status (p=0.04) retained significant as prognostic factors for overall survival (p=0.001). In patients younger or older than 60 years, age-adjusted prognostic index based on tumor stage, serum LDH levels, PS, and ENI identified four risk groups with predicted five-year survival rates of 56%-38%, 42%- 42%, and 0%-38%. Conclusion: Elderly patients have a poor outcome than younger patients but age alone is not sufficient to discriminate patients with a poor outcome. However, achievement of complete response and performance status are additional important prognostic factors. Response to treatment and PS may define a subgroup of patients with a poor outcome between the two age groups. Key words: Age, elderly patients, non-Hodgkin\'s lymphoma

Keywords

Age, elderly patients, non-Hodgkin’s lymphoma

References

• Greiner TC, Medeiros LJ, Jaffe ES. Non- Hodgkin‘s lymphoma. Cancer 1995;75: 370-80
• Rabkin CS, Devesa SS, Zahm SH, Gail MH. Increasing incidence of non- Hodgkin‘s lymphoma. Semin Hematol 1993;30:286-96
• Ansell SM, Falkson G, van der Merwe R, Uys A. Chronological age is a multifactorial prognostic variable in patients with non-Hodgkin‘s lymphoma. Ann Oncol 1992;3:45-50
• Vose JM, Armitage JO, Weisenburger DD, et al. The importance of age in survival of patients treated with chemotherapy for aggressive non-Hodgkin‘s lymphoma. J Clin Oncol 1988;6:1838-44 International 5. The Non-Hodgkin‘s Lymphoma Prognostic Factors Project: A predictive model for aggressive non- Hodgkin‘s lymphoma. N Eng J Med 1993;329(14):987-94
• Miller AB, Hoogstraten B, Staquet M, et al. Reporting results of cancer treatment. Cancer 1981;47:207-14
• Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81
• Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 1966;50:163-70
• Cox DR. The analysis of binary data. New York: Chapman and Hall, 1970
• Trelli U, Zagonel V, Serraino D, et al. Non- Hodgkin’s lymphomas in 137 patients age 70 years or older: A retrospective European Organization for Research and Treatment of Cancer lymphoma group study. J Clin Oncol 1988;6:1708-13
• Trelli U, Zagonel V, Sorio R, et al. Mitoxantrone in combination with etoposide and prednimustine in patients older than 70 years with unfavorable non-Hodgkin’s lymphoma: A prospective study in 52 patients. Semin Oncol 1994;31:13-22
• d’Amore F, Brincker H, Christensen BE, et al. Non-Hodgkin’s lymphoma in the elderly. A study of 602 patients aged 70 or older form a Danish population-based registry. Ann Oncol 1992;3:379-86
• Grogan L, Corbally N, Dervan PA, et al. Comparable prognostic factors and survival in elderly patients with aggressive non-Hodgkin’s lymphoma treated with standard-dose adriamycin- based regimens. Ann Oncol 1994;5:47- 51
• Velasquez WS, McLaughlin P, Fuller MN, et al. Intermediate grade lymphomas treated with v i n c r i s t i n e - p r e d n i s o n e - b l e o m y c i n alternated methotrexate-etoposide-dexamethasone. Cancer 1994;73:2408-16
• Zagonel V, Babare R, Merole MC, et al. Cost benefit of granulocyte stimulating factor administration in older patients with non-Hodgkin’s lymphoma treated with combination chemotherapy. Ann Oncol 1994;5:127-32
• Gaynor ER, Dahlberg S, Fisher RI. Factors affecting reduced survival of the elderly with intermediate and high grade lymphoma. Proc Annu Meet Am Soc Clin Oncol 1994;13:1250
• O’Reilly SE, Connors JM, Howdle S, Hoskins P, Klasa R, Klimo P, Stuart DS. In search of an optimal regimen for elderly patients with advanced stage diffuse large cell lymphoma: Results of a Phase II study of P/DOCE chemotherapy. J Clin Oncol 1993;11:2250-7
• Vose JM, Armitage JO, Weisenbruger DD, et al. The importance of age in survival of patients treated with chemotherapy for aggressive non-Hodgkin’s lymphoma. J Clin Oncol 1988;6:1838-44
• Kovner F, Merimsky O, Inbar M, et al. Prognostic importance of advanced age in aggressive non-Hodgkin’s malignant lymphoma. Oncology 1996;53:435-40
• Licht JD, Bosserman LD, Andersen JW, et al. Treatment of low-grade and intermediate-grade intensive combination chemotherapy results in long-term disease-free survival. Cancer 1990;66:632-9 lymphoma with
• Hoerni B, Sotto J, Eghbali H, Sotto M, Hoerni-Simon G, Pegourie B. Non- Hodgkin’s malignant lymphomas in patients older than 80. Cancer 1988;61: 2057-9
• Dumontet C, Anderson J, Sebban C, et al. Elderly non-Hodgkin lymphoma patients have comparable prognostic factors but a poor outcome than younger patients. Proc ASCO 1982;11:328