Different age limits for elderly patients with indolent and aggressive non-Hodgkin lymphoma and the role of relative survival with increasing age - Analysis of a population-based non-Hodgkin lymphoma registry

BACKGROUND. There is no consistent definition at what age patients with non -Hodgkin lymphoma (NHL) are considered "elderly." This might hamper well ba lanced decisions with respect to treatment. METHODS. From a population-based NHL registry the age groups younger than 6 0 years, 60-64 years, 65-69 years, 70-74 years, and 75 years and older were analyzed in relation to the revised European-American lymphoma classificat ion and to the age-adjusted International Prognostic Index (IPI). The progn ostic value of the variables from the age-adjusted IPI was determined. The relative survival probabilities were calculated. RESULTS. The incidence of diffuse large B-cell lymphoma (DLBL) increased wi th advancing age, as was the case for small lymphocytic lymphomas. Follicul ar lymphomas were less frequently encountered with advancing age. With resp ect to the so-called indolent lymphomas, a decreasing complete remission ra te and overall survival rate (5-year) was observed for patients older than 70 years, whereas patients with DLBL fared worse when older than 65 years a nd 60 years, respectively. The age-adjusted IPI score was discriminative fo r prognosis. However, even with an IPI score nil, the age group older than 75 years fared significantly worse (P < 0.009), but less so with the relati ve survival model. The relative survival at 5 years was 60%, 53%, 48%, 35%, and 32% for the 5 respective age groups. CONCLUSIONS. Patients with indolent lymphomas become elderly when they are older than 70 years, but when aggressive lymphoma is concerned this occurs when patients are older than 65 years. For patients with an IPI score nil, age older than 75 years is the dominant prognostic factor. The negative inf luence of concomitant disease on overall survival, although continuously in creasing in older age groups, seems to diminish for patients older than 75 years when compared with the general Dutch population. Cancer 2000;89:2667- 76. (C) 2000 American Cancer Society.