Abstract 3124

Background:

The incidence of NHL increases exponentially with rising age. The most rapidly growing segment of the population is persons > age 65 years, especially > age 80. As a percentage of US population, the age group >80 years has increased by >250% from 1960 to 2000. Furthermore, persons >80 years will more than double within 20 years. However, little data is available regarding the characteristics or outcomes of very elderly NHL patients (pts).

Methods:

We completed a multicenter retrospective analysis of very elderly NHL pts (=/> 80) diagnosed (dx) between 9/99-9/09 at 4 Chicago centers. Detailed pt and disease characteristics were collected including comorbidities, which were assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Pts were also classified if they were “fit” (i.e., preserved activities of daily living (ADLs), <3 grade 3 CIRS-G, no grade 4, and no geriatric syndrome: dementia, delirium, depression, incontinence, falls, neglect/abuse, or failure to thrive).

Result:

We identified 150 pts (F:M 1.14) with a median age of 84 years (80-96). 74 pts had aggressive NHL histology: DLBCL n=56 (systemic n=49, primary CNS n=5, gastric n=1, PEL n=1), T-cell n=11 (peripheral n=7, Sezary n=4) and MCL n=7. 76 pts had indolent NHL: follicular n=32, mycoses fungoides n=16, MZL n=17, CLL/SLL n=8 and lymphoplasmacytic n=4. Disease characteristics at dx included: B symptoms 20%, PS 2–3 18%, marrow involvement 35%, >1 extranodal 20%, elevated LDH 38%, anemia 41%, thrombocytopenia 16%, renal insufficiency 25%, and 36% had a history of coronary artery disease. Additionally, 28% had prior malignancy. Comorbidities were common; 77% of pts had a cumulative CIRS score >6, while 74% had a grade 3–4 CIRS-G in at least 1 category. Furthermore, 33% were classified as “not fit” at NHL dx, 12% had loss of ADLs, while 22% had a geriatric syndrome at time of NHL dx. 57% had stage III/IV disease. Pts with aggressive B cell histology received a rituximab (R)-containing regimen 85% of the time, while 84% of all aggressive NHL received at least one cycle with an anthracycline. Initial therapy for B cell indolent NHL were: observation (24%), R alone (35%), R-chemotherapy (CT) (31%), radiation (8%), and CT alone (2%). Among all pts, the overall response to first treatment was 68% (CR 49%). With 40-month median follow-up (1-120), 3-year EFS (event-free survival) and OS (overall survival) for all pts were 43.8% and 70.3%, respectively (stage I/II: EFS 49% and OS 81%; stage III/IV: EFS 42% and OS 65%; p=0.039 and p=0.09, respectively). Among aggressive NHL (n=74), 3-year EFS and OS were 55% and 64% (stage I/II: EFS 86% and OS 94%; stage III/IV: EFS 45% and OS 57%; p=0.0006 and p=0.03, respectively), while for indolent NHL (n=76), the 3-year EFS and OS were 34% and 77%, respectively (Figures 1–3). Prognostic factors predicting survival are shown in Table 1. In multivariate regression analyses, no response to initial therapy (i.e., SD/PD) predicted for significantly inferior EFS and OS (HR 5.45 [2.02-13.65], p=0.0007 and HR 6.88 [1.66-28.44], p=0.008, respectively).

Conclusion:

Long-term survival of very elderly NHL was feasible with 64% and 77% 3-year OS for aggressive and indolent histologies, respectively. However, comorbidities as well as a designation of “unfit” portended a significantly inferior outcome in univariate models. Primary resistance to initial therapy occurred in 32% of pts and also predicted for poor prognosis. Given the rising incidence and prevalence of very elderly NHL, prospective examination of this subset of pts is strongly warranted.

Table 1.

Prognostic factors (univariate).*

FactorEFSOS
HR95%CIPHR95%CIP
Presence of diabetes 0.73 0.55–0.98 0.03 0.81 0.55–1.17 0.26 
Low albumin 1.53 0.87–2.71 0.14 2.49 1.26–4.95 0.009 
Presence of geriatric syndrome 1.83 0.95–3.54 0.07 1.65 0.71–3.80 0.24 
Elevated LDH 2.26 1.26–4.07 0.006 2.33 1.11–4.87 0.03 
Loss of ADLs 2.86 1.46–5.61 0.002 3.88 1.79–8.42 0.0006 
No response to initial therapy (PD/SD vs CR/PR) 3.14 1.82–5.39 <0.0001 2.77 1.39–5.51 0.004 
Pt not “fit” 3.28 1.74–6.17 0.0002 2.93 1.32–6.52 0.008 
FactorEFSOS
HR95%CIPHR95%CIP
Presence of diabetes 0.73 0.55–0.98 0.03 0.81 0.55–1.17 0.26 
Low albumin 1.53 0.87–2.71 0.14 2.49 1.26–4.95 0.009 
Presence of geriatric syndrome 1.83 0.95–3.54 0.07 1.65 0.71–3.80 0.24 
Elevated LDH 2.26 1.26–4.07 0.006 2.33 1.11–4.87 0.03 
Loss of ADLs 2.86 1.46–5.61 0.002 3.88 1.79–8.42 0.0006 
No response to initial therapy (PD/SD vs CR/PR) 3.14 1.82–5.39 <0.0001 2.77 1.39–5.51 0.004 
Pt not “fit” 3.28 1.74–6.17 0.0002 2.93 1.32–6.52 0.008 
*

Twenty-two factors included in the univariate analysis; only factors with p <0.10 shown here.

HR, hazard ratio; CI, confidence interval; PD, progressive disease; SD, stable disease; CR, complete remission, PR, partial remission.

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Figure 1.
Figure 1. Survival of all pts (n=150).
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Survival of all pts (n=150).

Figure 1.
Figure 1. Survival of all pts (n=150).
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Survival of all pts (n=150).

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Figure 2.
Figure 2. Aggressive NHL (n=74).
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Aggressive NHL (n=74).

Figure 2.
Figure 2. Aggressive NHL (n=74).
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Aggressive NHL (n=74).

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Figure 3.
Figure 3. Indolent NHL (n=76).
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Indolent NHL (n=76).

Figure 3.
Figure 3. Indolent NHL (n=76).
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Indolent NHL (n=76).

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Disclosures:

No relevant conflicts of interest to declare.

Topics:
albumins, anemia, anthracycline antibiotics, brachial plexus neuritis, cancer, chemotherapy regimen, comorbidity, complete remission, coronary arteriosclerosis, diabetes mellitus

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
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