Comparable prognostic factors and survival in elderly patients with aggressive non-Hodgkin's lymphoma treated with standard-dose Adriamycin-based regimens

Abstract

We retrospectively analysed the prognostic factors at diagnosis, clinical response, and survival of 192 patients with newly diagnosed aggressive NHL treated in a single institution between 1985 and 1991. Overall, 37. 5% (72/192) of patients were 65 years or older (average age 71 years, range 65–85 years), and 62. 5% (120/192) were under 65 years of age (average age 45, range 16—64 years). All patients were completely staged and had intermediate- or high-grade NHL. 127 patients were treated on similar regimens with the same chemotherapy dose intensity irrespective of age. Standard-dose m-BACOD (methotrexate, bleomycin, Adriamycin, cyclophosphamide, vincristine, prednisone) or CHOP were used to treat 60/72 (83%) elderly patients and 67/120 (56%) patients less than 65 years. The remaining younger patients were treated with more intensive regimens. There were no significant differences between the groups with regard to stage, histological grade, cell type, elevated LDH, number of extranodal sites, presence of B symptoms, or bulky disease. More elderly patients had a significantly (p < 0. 02) poorer performance status (PS), with 42% (25/ 60) having a PS of 2 or more, compared to 22% (15/67) in those less than 65 years of age. Elderly patients had an inferior complete response rate, 65% versus 76%. However, overall response rates of 95% and 92% were similar. The disease-free survival at 3 years for complete responders in elderly patients was 74% compared to 82% in those under 65. The comparable 3-year overall survival was 59% and 62%, respectively. These results suggest that the majority of elderly patients do just as well as younger patients when treated with standard-dose Adriamy-cin regimens and can and should be treated with curative intent.