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Clinical Presentation and Outcome in Patients of over 75 Years Old with Malignant Lymphoma—Clinical Presentation and Outcome in Elderly Lymphoma Patients

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DOI: 10.4236/ijcm.2011.23039    3,966 Downloads   6,579 Views   Citations

ABSTRACT

We analyzed the relationship between the clinical characteristics, comorbidity, average relative dose intensity (aRDI) and outcome in patients of over 75 years old with malignant lymphoma. Of the 98 patients studied, the mean age was 79.9 years, and 68 patients (69.4%) had B-cell lymphomas, corresponding to mainly diffuse large B-cell lymphoma. The 5-year overall survival rate was 32.2% in 97 malignant lymphoma patients. T/NK subtype, poor performance status (PS) and high-intermediate/high international prognostic index (IPI) were found to be predictive of significantly poorer overall survival, as is the case in young patients. Correlation between comorbidity index and survival rate was not observed. We also analyzed the aRDI of cyclophosphamide and pirarubicin for 64/97 patients. The proportion of patients receiving ≤84% of the planned DI during five cycles gradually increased. Most patients could not maintain aRDI ≥85%. However, overall survival was not significantly different between patients with aRDI ≥0.85 and those with aRDI ≤0.84. In conclusion, the prognoses of very elderly patients with malignant lymphoma were not so poor when they were appropriately treated with modification of the applied dose and the duration of chemotherapy according to their status.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

N. Fukushima, F. Itamura, C. Urata, M. Tanaka, T. Hisatomi, Y. Kubota, E. Sueoka and S. Kimura, "Clinical Presentation and Outcome in Patients of over 75 Years Old with Malignant Lymphoma—Clinical Presentation and Outcome in Elderly Lymphoma Patients," International Journal of Clinical Medicine, Vol. 2 No. 3, 2011, pp. 246-253. doi: 10.4236/ijcm.2011.23039.

References

[1] White paper on the aging society in 2010. Cabinet Office, Government of Japan, 2010. (Japanese).
[2] Marugame, T, Kamo, K, Katanoda, K, Ajiki, W, Sobue, T. Cancer incidence and incidence rates in Japan in 2000: Estimates based on data from 11 population-based cancer registries. Jpn J Clin Oncol 2006; 36: 668-675.
[3] The International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictivemodel for aggressive non- Hodgkin’s lymphoma. N Engl J Med. 1993; 329: 987- 994.
[4] Solal-Céligny P, Roy P, Colombat P, White J, Armitage JO, Arranz-Saez R et al. Follicular lymphoma interna- tional prognostic index. Blood 2004; 104: 1258-1265.
[5] Vose JM, Armitage JO, Weisenburger DD, Bierman PJ, Sorensen S, Hutchins M et al. The importance of age in survival of patients treated with chemotherapy for aggres- sive non-Hodgkin’s lymphoma. J Clin Oncol 1988; 6: 1838-1844.
[6] Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML et al. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood. 1994 84: 1361-92.
[7] Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. WHO Classification of Tumors. Pathology and Genetics of Tu- mors of Haematopoietic and Lymphoid Tissues. Lyon: IARC Press, 2001.
[8] Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in lon- gitudinal studies: development and validation. J Chronic Dis. 1987; 40: 373-383.
[9] Etienne A, Esterni B, Charbonnier A, Mozziconacci MJ, Arnoulet C, Coso D et al. Comorbidity is an independent predictor of complete remission in elderly patients re- ceiving induction chemotherapy for acute myeloid leu- kemia. Cancer 2007; 109: 1376-1383.
[10] Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk as- sessment before allogeneic HCT. Blood 2005; 106: 2912- 2919.
[11] Epelbaum R, Haim N, Ben-Shahar M, Ron Y, Cohen Y. Dose-intensity analysis for CHOP chemotherapy in dif- fuse aggressive large cell lymphoma. Isr J Med Sci. 1988: 533-538.
[12] Lyman GH, Dale DC, Friedberg J, Crawford J, Fisher RI. Incidence and predictors of low chemotherapy dose-in- tensity in aggressive non-Hodgkin’s lymphoma: a na- tionwide study. J Clin Oncol 2004; 22: 4302-4311.
[13] Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457- 481.
[14] Thieblemont C, Grossoeuvre A, Houot R, Broussais- Guillaumont F, Salles G, Traullé C et al. Non-Hodgkin’s lymphoma in very elderly patients over 80 years. A de- scriptive analysis of clinical presentation and outcome. Ann Oncol 2008; 19: 774-779.
[15] Mori M, Kitamura K, Masuda M, Hotta T, Miyazaki T, Miura AB et al. Long-term results of a multicenter ran- domized, comparative trial of modified CHOP versus THP-COP versus THP-COPE regimens in elderly pa- tients with non-Hodgkin's lymphoma. Int J Hematol 2005; 81: 246-254.
[16] Pfreundschuh M, Schubert J, Ziepert M, Schmits R, Mohren M, Lengfelder E et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet On- col 2008; 9: 105-116.
[17] Pfreundschuh, M. How I treat elderly patients with dif- fuse large B-cell lymphoma. Blood 2010 in press.
[18] Lim ST, Hee SW, Quek R, Tao M. Performance status is the single most important prognostic factor in lymphoma patients aged greater than 75 overriding other prognostic factors such as histology. Leuk Lymphoma 2008; 49: 149-151.
[19] Armitage JO. Is lymphoma occurring in the elderly the same disease? Leuk Lymphoma 2008; 49: 14-16.
[20] Huerta, AS, Gómez-Codina, J, Pastor, M, Gironés, R, Pérez-Fidalgo, JA, Díaz, R. Non-Hodgkin's lymphoma in older people: age is not always an adverse prognostic factor. J Am Geriatr Soc 2002; 50(11): 1911-2.
[21] Giles FJ, Borthakur G, Ravandi F, Faderl S, Verstovsek S, Thomas D et al. The haematopoietic cell transplantation comorbidity index score is predictive of early death and survival in patients over 60 years of age receiving induc- tion therapy for acute myeloid leukaemia. Br J Haematol 2007; 136: 624-627.
[22] Vey N, Coso D, Bardou VJ, Stoppa AM, Braud AC, Bouabdallah R et al. The benefit of induction chemother- apy in patients age Cancer 2004; 101: 325-331.
[23] Sorror ML, Giralt S, Sandmaier BM, De Lima M, Shah- jahan M, Maloney DG et al. Hematopoietic cell trans- plantation specific comorbidity index as an outcome pre- dictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences. Blood 2007; 110: 4606-4613.
[24] Bastion Y, Blay JY, Divine M, Brice P, Bordessoule D, Sebban C, Blanc M et al. Elderly patients with aggressive non-Hodgkin’s lymphoma: disease presentation, response to treatment, and survival—a Grouped’Etude des Lym- phomes de l’Adulte study on 453 patients older than 69 years. J Clin Oncol 1997; 15: 2945-2953.
[25] Tsukasaki, K, Utsunomiya, A, Fukuda, H, Shibata, T, Fukushima, T, Takatsuka, Y et al. Japan Clinical Oncol- ogy Group Study JCOG9801. VCAP-AMP-VECP com- pared with biweekly CHOP for adult T-cell leuke- mia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol 2007; 25: 5458-5464.
[26] Fukushima T, Miyazaki Y, Honda S, Kawano F, Moriu- chi Y, Masuda M, et al. Allogeneic hematopoietic stem cell transplantation provides sustained long-term survival for patients with adult T-cell leukemia/lymphoma. Leu- kemia 2005: 19; 829-834
[27] Shiratori S, Yasumoto A, Tanaka J, Shigematsu A, Ya- mamoto S, Nishio M et al. A retrospective analysis of al- -logeneic hematopoietic stem cell transplantation for adult T cell leukemia/lymphoma (ATL): clinical impact of graft-versus-leukemia/lymphoma effect. Biol Blood Mar- row Transplant. 2008; 14: 817-823.
[28] Kwak LW, Halpern J, Olshen RA, Horning SJ. Prognos- tic significance of actual dose intensity in diffuse large- cell lymphoma: Results of a treestructured survival analy- sis. J Clin Oncol 1990: 8: 963-977.

  
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