Age as the main prognostic factor in adult aggressive non-Hodgkin's lymphoma

Solal‐Céligny, Philippe; Chastang, Claude; Herrera, A.; Desaint, B.; Renoux, M; Gaulard, Philippe; Bernard, Jean‐François; Brousse, Nicole; Boivin, Pierre

doi:10.1016/0002-9343(87)90944-2

Cited by 74 publications

(20 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Advanced age is known to be an adverse prognostic factor in all subtypes of NHL [14][15][16][17][18][19][20]. In the clinical evaluation of the REAL classification, 1403 patients were analyzed for the effect of age on the characteristics and clinical behavior of NHL [4].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Non-Hodgkin's lymphoma in patients 80 years of age or older

et al. 2006

View full text Add to dashboard Cite

Background: Very elderly patients ( ‡80 years old) with non-Hodgkin's lymphoma (NHL) frequently have co-morbid conditions and are generally excluded from clinical trials or even from treatment. The optimal treatment of these patients is unknown. Patients and methods:We reviewed the records of 109 patients ‡80 years at diagnosis of NHL (65 F/44 M; median age: 84 years, range; 80-95).Results: Seventy-eight patients (72%) had aggressive NHL, 25 (23%) had indolent and NHL, eight had unclassified disease. Advanced-stage disease was noted in 54%. Forty patients (39%) had a poor ECOG performance status (PS), and 52 (49%) had an intermediate or high risk International Prognostic Index (IPI). Seventy-nine patients (72%) were treated with chemotherapy and 37 (34%) with radiotherapy. Initial chemotherapy consisted of chlorambucil in 15, oral etoposide in 2, and combination protocol in 62. Only 16% of patients received full-dose therapy, and only 50% completed ‡6 cycles of combination chemotherapy. The overall response rate for the 69 evaluable patients was 84% (complete 56.5%, partial 27.5%). Overall 5-year survival for the whole group was 39%, and median survival time was 26 months. Conclusion:A high response rate can be achieved in very elderly NHL patients despite aggressive histology, poor prognostic features, and reduced doses of chemotherapy. Age alone should not be a contraindication to treatment.Key words: combination chemotherapy, non-Hodgkin's lymphoma, radiotherapy, survival, very elderly patients introduction The number of people living longer than 65 years has more than doubled over the last century and it is expected to double again over the next 50 years, and to quadruple for the over-85-year age group [1].Non-Hodgkin's lymphoma (NHL) is the sixth most common cancer, and the sixth most common cause of death in men and the seventh in women [2]. The risk of NHL rises with age, from 0.15 (1 in 658) from birth through age 39 years to 1.25 (1 in 80) from age 60 to 79 years (1). Moreover, the incidence of NHL has been increasing by 1-2% annually over the past 2 decades, most dramatically in people over 60 years old. The greatest change in incidence was noted in older (75-84 years) white men, in whom the rate rose from 19 per 100 000 person-years to 99 per 100 000 person-years [3]. Accordingly, NHL has become an increasingly important cause of morbidity and mortality in the aging population. Age greater than 60 years is a recognized adverse prognostic factor for NHL. Overall survival decreases with increasing age, and patients over 70 years old have worse outcomes than patients 60 to 70 years old [4]. Several factors may account for this finding [5]:• Differences in disease biology by age group.• Presence of co-morbid illnesses which are more common in the elderly.• Altered pharmacokinetics in the elderly and poorer host tissue tolerance.• Changes in bone marrow hematopoietic reserve and microenvironment with increasing age, which may lead to increased treatment-related myelotoxicity.• Higher rate of treatment-rela...

show abstract

Section: Discussionmentioning

confidence: 99%

“…The inclination to under-treat may be the result of early reports of high rates of treatment-related morbidity and mortality in older patients [14][15]. In 1984, Armitage and Potter [14] reported on 20 patients aged 70-94 years who were treated with full-dose CHOP with a treatment-related mortality of 30%.…”

Section: Discussionmentioning

confidence: 99%

Non-Hodgkin's lymphoma in patients 80 years of age or older

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Initiatives to improve cytotoxic delivery without compromising benefit have led investigators to develop weekly, multiagent chemotherapy regimens. [20][21][22][23]25,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] Improvements in supportive care enable the delivery of chemotherapy at standard doses and intensity to deliver maximum benefit to patients. 56 The minimum age of entry of 60 was chosen because patients younger than this were eligible for high-dose regimens and because this age carried prognostic significance in the international prognostic index (IPI) analyses.…”

Section: Discussionmentioning

confidence: 99%

Mitoxantrone is superior to doxorubicin in a multiagent weekly regimen for patients older than 60 with high-grade lymphoma: results of a BNLI randomized trial of PAdriaCEBO versus PMitCEBO

Mainwaring

Cunningham

Gregory

et al. 2001

Blood

View full text Add to dashboard Cite

A prospective, multicenter, randomized trial was undertaken to compare the efficacy and toxicity of adriamycin with mitoxantrone within a 6-drug combination chemotherapy regimen for elderly patients (older than 60 years) with highgrade non-Hodgkin lymphoma (HGL) given for a minimum of 8 weeks. A total of 516 previously untreated patients aged older than 60 years were randomized to receive 1 of 2 anthracycline-containing regimens: adriamycin, 35 mg/m 2 intravenously (IV) on day 1 (n ‫؍‬ 259), or mitoxantrone, 7 mg/m 2 IV on day 1 (n ‫؍‬ 257); with prednisolone, 50 mg orally on days 1 to 14; cyclophosphamide, 300 mg/m 2 IV on day 1; etoposide, 150 mg/m 2 IV on day 1; vincristine, 1.4 mg/m 2 IV on day 8; and bleomycin, 10 mg/m 2 IV on day 8. Each 2-week cycle was administered for a minimum of 8 weeks in the absence of progression. Forty-three patients were ineligible for analysis. The overall and complete remission rates were 78% and 60% for patients receiving PMitCEBO and 69% and 52% for patients receiving PAdriaCEBO (P ‫؍‬ .05, P ‫؍‬ .12, respectively). Overall survival was significantly better with PMitCEBO than PAdriaCEBO (P ‫؍‬ .0067). However, relapse-free survival was not significantly different (P ‫؍‬ .16)

show abstract

“…It is all the more important as the median age of patients with NHL ranges from 60 to 65 years, 10 and age by itself is one of the most powerful prognostic factors in intermediate-and high-grade NHL. [11][12][13] Thus, in order to answer the question about the feasibility of PBSCT as front-line treatment up to the age of 65 years, we conducted a single-center prospective pilot study of such therapy in patients with aggressive NHL aged Ͻ60-65 years.…”

mentioning

confidence: 99%

Peripheral blood stem cell transplantation as front-line therapy in patients aged 61 to 65 years: a pilot study

Moreau

Milpied

Voillat

et al. 1998

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:The aim of the present trial was to investigate the feasibility of high-dose therapy followed by autologous peripheral blood stem cell transplantation (PBSCT) as a component of front-line treatment in patients with disseminated intermediate-and high-grade non-Hodgkin's lymphoma (NHL) aged 61-65 years. From October 1993 to June 1996, 14 consecutive patients entered this singlecenter prospective pilot trial. Patients were five males and nine females, median age 63 (range 61-65). The first-line treatment consisted of three courses of CHOP therapy. Patients achieving either a partial response (PR) or a complete response (CR) after initial therapy were eligible for PBSCT, while those with refractory or progessive disease were not autografted but included in the feasibility study in an intent-to-treat analysis. Of the 14 patients, 11 achieved either a CR (one) or a PR (10) after three courses of CHOP while the three patients with no response were not autografted and subsequently died of progressive disease. PBSC collection was feasible in responding patients after G-CSF priming (10 g/kg/day for 6 days). Conditioning therapy was the BEAM protocol. All patients engrafted after PBSCT. The median time to granulocyte (Ͼ0.5 × 10 9 /l) and platelet recovery (Ͼ25 × 10 9 /l) was 12 (range 9-18) and 13 days (range 7-22), respectively. No toxic deaths VOD or IP were observed. Four of the 11 responding patients relapsed 2, 7, 9 and 12 months after PBSCT, respectively, and all died from progressive disease. Overall, 7/14 patients are alive and free from disease, 16-43 months after initial diagnosis (median 28). The actuarial overall survival is 45.7 %, and the actuarial event-free survival is 50% at 3.5 years. This study shows the feasibility of high-dose therapy and PBSCT in patients with intermediate-or high-grade disseminated NHL aged 61-65 years. Such patients should not be excluded from trials evaluating the role of ASCT as part of initial treatment for disseminated and histologically aggressive NHL.

show abstract

Age as the main prognostic factor in adult aggressive non-Hodgkin's lymphoma

Cited by 74 publications

References 14 publications

Non-Hodgkin's lymphoma in patients 80 years of age or older

Non-Hodgkin's lymphoma in patients 80 years of age or older

Mitoxantrone is superior to doxorubicin in a multiagent weekly regimen for patients older than 60 with high-grade lymphoma: results of a BNLI randomized trial of PAdriaCEBO versus PMitCEBO

Peripheral blood stem cell transplantation as front-line therapy in patients aged 61 to 65 years: a pilot study

Contact Info

Product

Resources

About