RISK-FACTORS FOR TREATMENT-RELATED DEATH IN ELDERLY PATIENTS WITH AGGRESSIVE NON-HODGKINS-LYMPHOMA - RESULTS OF A MULTIVARIATE-ANALYSIS

Purpose: It has been suggested that age is associated with chemotherap y-related death in patients with non-Hodgkin's lymphoma (NHL) treated with doxorubicin-containing chemotherapy. The purpose of this study wa s to evaluate the relative influence of increasing age and other clini cal parameters on the occurrence of treatment-related death in elderly patients with intermediate-or high-grade NHL treated with cyclophosph amide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. M ethods: A retrospective study of patients 60 years of age or older wit h intermediate-or high-grade NHL treated with CHOP chemotherapy in a s ingle cancer center. The following variables were recorded: age (60 to 69, 70 to 79, and 80 to 94 years), histology (Working Formulation [WF ] D, E, F, G, and H), Ann Arbor stage, B symptoms, extranodal involvem ent, bulky disease (> 7 cm), performance status (Eastern Cooperative O ncology Group [ECOG] scale), International Prognostic Index (IPI score ), serum lactate dehydrogenase (LDH) level and doxorubicin relative do se-intensity (RDI). The relationship between these features and treatm ent-related death was assessed in univariate and multivariate logistic regression analysis. Results: From 1982 to 1991, 267 consecutive pati ents were treated. Median age was 70 years (range, 60 to 94 years). Th ere were 35 toxic deaths. Sixty-three percent of the deaths occurred a fter the first cycle. Infection accounted for 82% of the toxic deaths. In the univariate analysis, the features associated with an increased risk of toxic death were ECOG performance status 2 to 4 (relative ris k [RR], 7.82), B symptoms (RR, 3.38), diffuse large-cell histology (RR , 3.06), bulky disease (RR, 2.58), serum levels of LDH (RR, 2.53), and IPI score (RR, 2.46). The age groups did not show significance. In th e regression model, performance status 2 to 4 was the only independent predictor of treatment-related death (RR, 3.52; 95% confidence interv al [CI], 2.98 to 4.06). Conclusion: Our results show that in elderly p atients with NHL treated with doxorubicin-based chemotherapy the risk for treatment-related death is associated with poor performance status rather than with increasing chronologic age.