Non-Hodgkin's lymphomas in 137 patients aged 70 years or older: a retrospective European Organization for Research and Treatment of Cancer Lymphoma Group Study.

Abstract

The results of a European Organization for Research and Treatment of Cancer (EORTC) retrospective study on non-Hodgkin's lymphoma (NHL) in elderly patients (greater than or equal to 70 years of age) seen in Europe in 1984 are reported. A precodified form was sent to 55 European institutes in order to evaluate the incidence of NHL in the elderly with regard to natural history, treatment-related toxicity, response, and survival. Thirteen institutes participated in the study. One hundred thirty-seven cases of NHL were observed in the elderly during 1984, making up 28% of the total number of NHL seen in those institutes. The median age was 77 years; 21% of the patients had favorable (low-grade) and 73% unfavorable (intermediate- and high-grade) histology, according to the Working Formulation. Stage at presentation was localized (I and II) in 60% and advanced in 37% of the patients. Most of the physicians used standard therapy regimens at reduced doses, from the beginning of the treatment. Sixty patients (44%) underwent a "conservative" treatment (one or two antineoplastic drugs or local field radiotherapy) and 77 (56%) an "aggressive" treatment (polychemotherapy regimens or extended field radiotherapy). Response was similar between the two treatment groups, but severe and lethal toxicity was significantly higher among patients treated with aggressive therapy. Prospective randomized studies are clearly needed to define the optimal treatment in elderly patients with advanced unfavorable NHL.

Ex vivo assessment of drug response by differential staining cytotoxicity (DiSC) assay suggests a biological basis for equality of chemotherapy irrespective of age for patients with chronic lymphocytic leukaemia

“…24 CLL is eminently treatable and DiSC assay guided therapy can make economic sense; life could be extended for £1470 per life year gained, 25 and expensive and toxic therapy that is highly unlikely to be effective can be avoided. 8 Although studies have shown a significantly greater prevalence of severe and lethal toxicity in elderly lymphoma patients treated with intensive chemotherapy regimens, 26 age alone should not be the determining factor in modifying treatment in CLL. Cancer treatment in the elderly is remarkably safe when the co-morbid conditions are also treated.…”

Full Dose Chop Chemotherapy in Elderly Patients with Non-Hodgkin's Lymphoma

“…Indeed. a high rate of severe and lethal toxicity was found in elderly patients with N H L treated with intensive chemotherapy (17)(18)(19). This toxicity led many investigators to reduce drug doses in the initial cycle/s of chemotherapy in old patients ( 5 -8 ) , a policy which by itself could contribute to less favourable results.…”

Mitoxantrone, Etoposide and Prednisolone (NOVEP) in Previously Untreated Elderly Patients with Non-Hodgkin’s Lymphoma (NHL) and as Salvage Therapy for Refractory NHL

“…Deaths attributed to tumor or treatment-related toxi city were similar above and below the age of 60, but there was a significant difference (p = 0.005) due to other causes of death not obviously related to the lymphoma or its therapy. Many other studies were analyzed retrospectively [13,20,[40][41][42][43], Since the introduction of mitoxantrone as a single-agent therapy for NHL in 1982 by de Jager et al [24] several authors described monotherapy results with remission rates between 13 and 95% [22,23,26,31,33], Etoposide has been shown to be successful in NHL since the first study by the EORTC in 1973 and achieved remission in 21-60% [21,25,[27][28][29][30]32], Some others have used one of these two drugs in combination with other schedules [44][45][46][47][48] or both of them in combination with cytarabine and prednisone [49] or with ifosfamide [50], The 32 patients in our study receiving NOVEP as first-line therapy achieved CR in 41% and PR in 34%, leading to an overall response rate of 75%. All patients with NOVEP in first-line therapy were 60 years or older (range 64-84. median 76).…”