PROGNOSTIC FACTORS AND SURVIVAL IN NON-HODGKINS-LYMPHOMAS - THE EXPERIENCE OF THE ISTITUTO-ONCOLOGICO-ROMAGNOLO (IOR)

In an attempt to evaluate natural history, prognostic factors and surv ival, the data of 340 patients with NHL were collected. 267 patients w ere evaluable for the analysis of prognostic factors and survival. The tumor samples were reviewed and reclassified according to the Kiel cl assification. At completion, 180 patients were affected by low-grade ( LG)-NHL and 87 patients had high-grade (HG)-NHL. Numerous potential pr ognostic factors were analysed in univariate and multivariate analyses . Globally 154 patients (57.4%) obtained complete remission (CR) and 6 5 patients (24.3%) partial remission (PR). The response rate was simil ar in LG and HG-NHL groups. 5-years survival was 52% for all patients (53% in LG-NHL and 44% in HG-NHL). Median survival was 62 months in LG -NHL and 38 months in HG-NHL (p = n.s.). At the univariate analysis ov erall survival (OS) in LG-NHL was favourably influenced by age <65 yea rs (p = 0.004), performance status >80 (p < 0.02), early clinical stag e (p < 0.001), absence of systemic symptoms (p < 0.001), low serum LDH (p < 0.001) and achievement of CR (p < 0.001), while in the HG-NHL on ly by age (p = 0.005) and achievement of CR (p < 0.001). The multivari ate analysis showed early clinical stage, low serum LDH, absence of sy stemic symptoms and achievement of CR as independent prognostic factor s in LG-NHL and only achievement of CR in HG-NHL. The univariate analy sis for disease free survival (DFS) showed age (p < 0.001), clinical s tage (p < 0.001), systemic symptoms (p < 0.001), serum LDH (p < 0.001) and bulky disease (p = 0.03) as prognostic factors in LG-NHL and age (p = 0.006) in HG-NHL. At the multivariate analysis early clinical sta ge and low serum LDH appeared as independent prognostic factors in LG- NHL, whereas it was age in HG-NHL. Age and achievement of CR appear to be the most important prognostic factors for OS and DFS bath in LG an d HG-NHL and, in particular, the achievement of CR is extremely import ant in improving the prognosis regardless of the type of therapy adopt ed. In the near future the maximum effort should be made to ameliorate the quality of the treatments in an aim to attain the CR so as to hav e the opportunity to cure the largest possible number of patients with NHL.