NON-HODGKINS-LYMPHOMA IN THE OLDER PERSON - A REVIEW

Objective: To study the epidemiology of non-Hodgkin's Lymphoma (NHL) i n the older person and to explore treatment strategies for older perso ns with NHL. Design: Review of the English literature. Measurements: I ncidence of NHL in patients of different ages; prevalence of NHL of di fferent grades and stages in persons of different ages; and response t o treatment, disease free survival, and survival, for patients of diff erent ages. Results: The incidence of NHL in the aged has increased ap proximately 80% since 1970, and approximately one-half of the 40,000 a nnual new cases occur in persons aged 60 and older in the USA. The 2-4 phenoxy pesticides may be partly responsible for this increment. The treatment of low grade lymphoma is mostly palliative and well tolerate d by the aged. Age may have an adverse effect on the prognosis of inte rmediate grade lymphomas, and the prevalence of poor prognostic factor s and comorbidity increases with age. Among persons aged 65-75, the co mplete response rate (CRR) of intermediate grade NHL to chemotherapy i s approximately 50%, and approximately one-third of complete responder s remain alive and free of disease 5 years from diagnosis. Among those aged 75 and older, the CRR to chemotherapy is approximately 40%, and the median duration of response is 16 months. Strategies aimed to amel iorate treatment-related toxicity include lower doses of chemotherapy, choice of drugs better tolerated by older individuals, and prevention of chemotherapy-induced toxicity. Conclusions: NHL are an increasingl y common problem for older persons. Approximately 80% of older patient s with low grade lymphomas and 40%-50% of those with intermediate grad e lymphomas may benefit from chemotherapy. Individualized treatment, b ased on life expectancy and comorbidity, is the key to effective manag ement.