Effect of Age on Characteristics and Clinical Behavior of Adult Agressive Non-hodgkin's Lymphoma

Abstract

Aim: The importance of age as a prognostic factor in aggressive non-Hodgkin's lymphoma (NHL) remains controversial. It is not clear whether age is an independent factor or reflecting the limited physiologic reserves of the patients. Methods: We retrospectively analyzed prognostic factors according to age (≤60/>60) in 201 patients with aggressive NHL treated at our institution between 1989 and 1998 years. An age-adjusted prognostic index was used for younger and older than 60 years patients with aggressive NHL in order to give 5 years survival analysis. Results: Seventy-four (37%) of the patients were older than 60 years and 40 of these were male (54%). Older patients presented with more advanced disease than younger patients (p=0.01). Median follow-up in younger and older patients were 37.6 (range 1-120), and 20.8 (range 1-58) months, respectively. Median survival in younger and older patients were 75 months and 29 months, respectively (p=0.0001). Five years overall survivals rates in younger and older patients were 52% and 40%, respectively (p=0.036). There were significant differences in the median survival according to prognostic factors [sex, performance status (PS), B symptoms, stage, bulky disease, extra-nodal involvement site (ENI), histologic grade, response to treatment, serum lactate dehydrogenase (LDH), β2-microglobulin and albumin levels)] between the two age groups in univariate analyses (p=0.001). In the multivariate analyses response to treatment (complete response and not complete response) (p=0.005), and performance status (p=0.04) retained significant as prognostic factors for overall survival (p=0.001). In patients younger or older than 60 years, age-adjusted prognostic index based on tumor stage, serum LDH levels, PS, and ENI identified four risk groups with predicted five-year survival rates of 56%-38%, 42%-42%, and 0%-38%. Conclusion: Elderly patients have a poor outcome than younger patients but age alone is not sufficient to discriminate patients with a poor outcome. However, achievement of complete response and performance status are additional important prognostic factors. Response to treatment and PS may define a subgroup of patients with a poor outcome between the two age groups.