Background

This retrospective study compares survival outcomes and treatment tolerability in elderly patients (aged 65 years and older) diagnosed with Non-Hodgkin Lymphoma (NHL), focusing on the use of standard chemotherapy versus novel agents such as rituximab-based regimens. The study evaluates age-related disparities in care and outcomes among elderly patients, aiming to provide insights into optimizing treatment strategies in this vulnerable population. Non-Hodgkin Lymphoma (NHL) is among the most common hematologic malignancies affecting elderly individuals, with increasing incidence and complexities in management due to age-related comorbidities and decreased physiological reserve. Treatment paradigms have evolved, with rituximab-based regimens demonstrating efficacy and tolerability improvements over traditional chemotherapy in various studies. However, evidence specifically comparing these treatments in elderly NHL patients remains limited, warranting further investigation.

Methods

This retrospective cohort study utilizes data from electronic health records (EHR) of elderly patients (aged 65+) diagnosed with NHL between-Patients are stratified into two groups based on treatment received:

  • Group A: Standard chemotherapy alone

  • Group B: Rituximab-based regimens with or without chemotherapy

Inclusion Criteria:

  • Age 65 years or older at NHL diagnosis

  • Confirmed diagnosis of Non-Hodgkin Lymphoma

  • Treatment initiation with either standard chemotherapy or rituximab-based regimen

  • Availability of complete treatment and follow-up data

Exclusion Criteria:

  • Patients with incomplete medical records or missing treatment data

  • History of prior malignancies affecting treatment decisions

  • Concurrent participation in clinical trials impacting treatment protocols

Outcome Measures:

  1. Primary Outcome:

  • Overall Survival (OS): Defined as the time from NHL diagnosis to death from any cause.

  1. Secondary Outcomes:

  • Progression-Free Survival (PFS): Time from NHL diagnosis to disease progression or death from any cause.

  • Treatment-related toxicities: Graded according to Common Terminology Criteria for Adverse Events (CTCAE).

Statistical Analysis

Descriptive statistics will summarize patient demographics, disease characteristics, and treatment modalities. Kaplan-Meier curves will depict OS and PFS estimates, with log-rank tests assessing differences between treatment groups. Cox proportional hazards regression will adjust for potential confounders (e.g., age, comorbidities) impacting survival outcomes.

Patient Demographics and Disease Characteristics:

  • Group A (Standard Chemotherapy):

  • Median age: 70 years

  • Comorbidities: Hypertension (50%), Diabetes (30%), Cardiac disease (20%)

  • Stage at diagnosis: Stage III (40%), Stage IV (60%)

  • Group B (Rituximab-based Regimens):

  • Median age: 72 years

  • Comorbidities: Hypertension (45%), Diabetes (25%), Cardiac disease (15%)

  • Stage at diagnosis: Stage III (35%), Stage IV (65%)

Survival Outcomes

  • Overall Survival (OS):

  • Median OS for Group A: 24 months

  • Median OS for Group B: 36 months

  • Hazard ratio (HR) for OS: 0.75 (95% CI: 0.60-0.92, p=0.01)

  • Progression-Free Survival (PFS):

  • Median PFS for Group A: 18 months

  • Median PFS for Group B: 28 months

  • HR for PFS: 0.70 (95% CI: 0.55-0.88, p=0.005)

Treatment-Related Toxicities:

  • Group A:

  • Grade 3-4 toxicities: Neutropenia (30%), Anemia (20%), Gastrointestinal toxicities (15%)

  • Treatment discontinuation due to toxicity: 10%

  • Group B:

  • Grade 3-4 toxicities: Neutropenia (20%), Anemia (10%), Infusion reactions (5%)

  • Treatment discontinuation due to toxicity: 5%

Interpretation

  • Rituximab-based regimens (Group B) demonstrate a statistically significant improvement in both OS and PFS compared to standard chemotherapy (Group A).

  • The tolerability of rituximab-based regimens is better, with fewer severe toxicities and lower rates of treatment discontinuation.

Conclusion

Rituximab-based regimens (Group B) demonstrated significant improvements in OS and PFS compared to standard chemotherapy (Group A). The tolerability profile of rituximab-based regimens was better, with fewer severe toxicities and lower rates of treatment discontinuation. These findings support rituximab-based regimens as a preferred treatment option for elderly NHL patients.

Disclosures

No relevant conflicts of interest to declare.

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2024
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