Trial Information

Retrospective Analysis of Histologies, Pattern of Care, and Outcomes of Non-Hodgkin Lymphoma in Elderly Patients Above the Age of 80 in the Rituximab Era: A Report From the Chicago Lymphoma Consortium

Non-Hodgkin Lymphoma (NHL) is a malignant disease of the lymphoid and hematopoetic system
with an annual incidence of 60,000 cases/year in the United States accounting for over
18,000 deaths annually. NHL is a heterogeneous malignancy with a median age of 65 at the
time of diagnosis. Most clinical trials that have established current standards of care did
not include elderly patients, especially those who are above the age of 80. Reasons for
such under representation are not well-defined but several factors are hypothesized.
Patients above the age of 80 have many co-morbid conditions that might exclude them from
enrollment on clinical studies that are usually designed for more fit individuals. In
addition, investigators are often reluctant to propose trials to elderly patients as their
response to therapy might be suboptimal compared with younger patients affecting the overall
data.

Well-designed published studies as to how patients over the age of 80 are being managed in
the community or academic setting are lacking. There is no agreed-upon treatment algorithm
for these patients and recommended approach varies based on the treating physician, the
institution, and each individual patient.

Some physicians chose to offer dose reductions while others might omit chemotherapy and use
monoclonal antibodies alone. Furthermore, treatment duration and the number of cycles given
might vary considerably in this patient subgroup for a variety of reasons, mainly toxicity.
In addition, it is unclear whether the histologic distribution of NHL is similar in older
patients. In other words, it is not clear whether patients over the age of 80 are commonly
diagnosed with diffuse large cell lymphoma (DLCL) and follicular lymphoma (FL) similar to
younger individuals. Most importantly, these expected variations in treatment strategies
might have inferior outcomes when compared to younger patient population. Looking at
histologic subtype, treatment strategies, and outcomes in patients over the age of 80 is
useful for patients and physicians alike. It is plausible that our current standards do not
apply to this very-older patient population arguing for offering them clinical trials or
novel agents even as an initial approach. On the other hand, we might discover that these
older patients fare well despite these variations arguing that their disease biology is
different especially if we note changes in histologic distribution.