Two studies presented at the 2008 meeting of the American Society of Clinical Oncology in Chicago, May 30-June 2, suggest that aggressive therapy can be administered successfully to patients with non-Hodgkin’s lymphoma (NHL) who are 80 years of age or older.

The incidence of NHL increases with age and an increase in the number of older patients with this disease is expected as patients live longer. However, very few if any very elderly patients are included in randomized trials evaluating different treatment regimens. Thus, the outcomes of treatment in various medical institutions become important. A previous study from Israel reported a high response rate in patients with NHL are 80 years of age or older (see first item of related news).

Researchers from the University of Nebraska reported outcome of 249 patients with NHL who were 80 years of age or older and were treated between 1982 and 2005.¹ More than half the patients were treated with CHOP or similar combinations with or without rituximab. They reported an overall response rate of 86%. For all patients the probabilities of five-year progression-free survival and overall survival were 22% and 28%, respectively. A high age adjusted international prognostic index was associated with a higher failure rate. Patients who completed four or more cycles of treatment or had radiation therapy had better outcomes. These authors concluded that anthracycline-based therapy was feasible in patients 80 years of age or older. However, the intensity of therapy was not tolerated in a many patients.

Researchers from the H. Lee Moffitt Cancer Center reported the outcome of 107 patients with NHL over the age of 80 treated between 2000 and 2005.² 28% received CHOP with or without rituximab, 42% received non-anthracycline containing regimens, and 30% were not treated. For the entire group, the one- and three-year survival rates were 61% and 22%, respectively. The median survival time was 21 months. Patients with indolent lymphoma had longer survivals than more aggressive lymphomas. Patients with aggressive NLH who received anthracyclines had better survivals than those receiving non-anthracycline regimens or no therapy. Chemotherapy did not appear to affect survival of patients with indolent NHL. These researchers concluded that CHOP and CHOP R improved survival of patients with aggressive NHL and that age alone should not be a contraindication to treatment.

Comments: These two studies attest to the growing interest in evaluating treatment of very elderly patients with NHL.

Related News:

Patients 80 Years or Older With NHL Benefit From Chemotherapy (8/15/2006)

NHL Patients Older than 65 Years of Age Benefit from Autologous Stem Cell Transplantation (3/11/2008)

Further Data Shows R-CHOP Improves Survival in Elderly Patients with NHL (1/22/2008)

High-Dose Bexxar® with Stem Cell Support Effective in Elderly B-Cell NHL (4/17/2007)

Short Course of Rituxan®/Chemotherapy Plus Maintenance Rituxan® Provides High Progression-Free Survival as Initial Treatment of Diffuse B-Cell NHL Among Patients Ineligible for Standard R-CHOP (6/21/2006)

Six Cycles of Rituxan®-CHOP14 Confirmed as Standard of Care for Elderly with Diffuse Large B-Cell Lymphoma (1/11/2007)

Reference:

¹ Koeneke TL, Wong P, RG Bociek, et al. Nebraska Lymphoma Study Group (NLSG) results for treatment for non-Hodgkin’s lymphoma (NHL). Journal of Clinical Oncology. 2008;26:abstract number 8534.

² Nascimento FO, Soares HP, Ruiz A, et al. Treatment and survival of non-Hodgkin lymphoma patients over the age of 80. Journal of Clinical Oncology. 2008;26:abstract number 8569