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Annals of Oncology Advance Access published online on February 28, 2006
Annals of Oncology, doi:10.1093/annonc/mdl034
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© 2006 European Society for Medical Oncology
Received October 28, 2005
Revised December 25, 2005
Accepted January 31, 2006

original article

Non-Hodgkin's lymphoma in patients 80 years of age or older

O. Bairey 1 *, O. Benjamini 2, D. Blickstein 1, A. Elis 2, and R. Ruchlemer 3

1 Institute of Hematology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel
2 Department of Internal Medicine ‘A’, Sapir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3 Institute of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel

* To whom correspondence should be addressed.
O. Bairey, E-mail: obairey{at}post.tau.ac.il


  Abstract

Background: Very elderly patients (≥80 years old) with non-Hodgkin's lymphoma (NHL) frequently have co-morbid conditions and are generally excluded from clinical trials or even from treatment. The optimal treatment of these patients is unknown.

Patients and methods: We reviewed the records of 109 patients ≥80 years at diagnosis of NHL (65 F/44 M; median age: 84 years, range; 80-95).

Results: Seventy-eight patients (72%) had aggressive NHL, 25 (23%) had indolent and NHL, eight had unclassified disease. Advanced-stage disease was noted in 54%. Forty patients (39%) had a poor ECOG performance status (PS), and 52 (49%) had an intermediate or high risk International Prognostic Index (IPI). Seventy-nine patients (72%) were treated with chemotherapy and 37 (34%) with radiotherapy. Initial chemotherapy consisted of chlorambucil in 15, oral etoposide in 2, and combination protocol in 62. Only 16% of patients received full-dose therapy, and only 50% completed ≥6 cycles of combination chemotherapy. The overall response rate for the 69 evaluable patients was 84% (complete 56.5%, partial 27.5%). Overall 5-year survival for the whole group was 39%, and median survival time was 26 months.

Conclusion: A high response rate can be achieved in very elderly NHL patients despite aggressive histology, poor prognostic features, and reduced doses of chemotherapy. Age alone should not be a contraindication to treatment.

Keywords: combination chemotherapy; non-Hodgkin's lymphoma; radiotherapy; survival; very elderly patients.
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