Elderly patients with non-Hodgkin's lymphoma: Population-based results in the Netherlands

Background. To compare characteristics, treatment and outcome of patients g reater than or equal to 70 years with patients <70 years in a population-ba sed non-Hodgkin's lymphoma (NHL) registry. Patients and methods: All new patients with NHL (n = 1168) in a geographica lly defined region in the western part of The Netherlands were registered d uring a nearly 10-year period. Patient, tumour and treatment characteristic s, response to therapy and survival were analysed for both age groups. An a ge-adjusted prognostic index was determined for elderly patients with aggre ssive lymphoma. Results: The elderly comprised 41% of the registered pa tients. There were significantly more females, a preponderance of intermediate-grade histology (diffuse large B-cell lymphoma) and a lower performance status. Incomplete staging in the elderly was mostly due to the omission of a bone marrow bio psy. With respect to WF grading the complete remission rate (except for pat ients with low-grade/stage I NHL, patients with extranodal NHL and for pati ents with intermediate grade/extensive NHL) and overall survival at five ye ars (except for patients with low-grade/stage I NHL and for patients with i ntermediate-grade/extensive NHL) were significantly inferior in the elderly . With respect to the R.E.A.L. Classification the exceptions were in patien ts with high grade MALT lymphomas (elderly good) and patients with mantle-c ell and peripheral T-cell lymphomas (younger group bad too). However, once complete remission was reached, the disease-free survival did not differ si gnificantly between the two age groups, emphasising the importance of achie ving complete remission. Although 65% of the classified elderly patients pr esented with intermediate-grade NHL, only 26% of the elderly patients treat ed with chemotherapy received anthracycline-based chemotherapy. In the elde rly, lymphoma (treatment-related toxicity included) contributed to death in 70% and concomitant disease (other malignancy included) in 30%, versus 78% and 22%, respectively, for the younger group (P = 0.04). The age-adjusted prognostic index, made up of the factors serum LDH, stage and Karnofsky ind ex, showed a clear distinction between the four risk categories low, low/in termediate, intermediate/high and high, with a median survival time of 43, 20, seven and four months, respectively. For the younger group the respecti ve numbers were 144, 45, 19 and 11 months. Conclusions. In a population-based NHL registry the elderly, predominately female patients, formed a larger proportion of the patient group than the o ne usually reported in the literature. In this population-based cohort infe rior remission and overall survival rates were seen in the elderly. However , obtaining complete remission was beneficial for the prognosis of this dis ease in the elderly. By the application of the R.E.A.L. Classification impo rtant subgroups emerge.