The effect of optimal treatment on elderly patients with aggressive non-Hodgkin's lymphoma: more patients treated with unaffected response rates

A substantial part of elderly patients (with good performance) with interme diate or high-grade non- Hodgkin's lymphoma (NHL) are not treated with the standard chemotherapy of cyclophosphamide, doxorubicin, vincristine, and pr ednisone (CHOP). If NHL patients are not treated with CHOP, the outcome is inferior. By adding granulocyte colony-stimulating factor (G-CSF) to CHOP c hemotherapy, we aimed at treating more patients with less toxicity. We perf ormed a multicenter population-based study (in the southeast of the Netherl ands) in which elderly patients (greater than or equal to 60 years) with in termediate or high-grade stage greater than or equal to IIB NHL were treate d with CHOP chemotherapy and growth factor G-CSF to increase the number of patients treated according to standard protocols. We also evaluated elderly NHL patients who were not treated with CHOP chemotherapy. Adequate therapy was defined as greater than or equal to six cycles or a total of five cycl es when complete remission was achieved after three cycles. Seventy-nine NH L patients fulfilled the selection criteria. The patients were treated with CHOP plus G-CSF (n=46), CHOP (n=19), cyclophosphamide, vincristine, and pr ednisone (COP) (n=2), chlorambucil and prednisone (n=2), or prednisone (n=1 ). Nine patients were not treated with chemotherapy. The median age was 72 years (60-87). Of the 79 NHL patients, 65 were treated with CHOP chemothera py (82%); 38 of 65 patients (59%) were adequately treated. The complete rem ission rate in the NHL group treated with CHOP was 65% (42 of 65 patients). The overall 3-year survival was 50%. Most of the patients died from progre ssive, NHL (53% in the CHOP and 77% in the group not treated with CHOP). Th e treatment-related mortality was 15% in the CHOP group. The most important reason for not treating patients with CHOP (with or without G-CSF) was poo r performance (WHO greater than or equal to2). A significant subset of pati ents can be treated with CHOP chemotherapy with acceptable toxicity. The co mbination of CHOP plus G-CSF increased the absolute number of treatable eld erly patients, resulting in more (absolute) patients with complete remissio n and overall survival compared to our previous study.