Abstract 3668

Background:

The prevalence of NHL in patients (pts) ≥ 80 years has recently tripled; however, data on prognostic factors and treatment for this very elderly population is sparse.

Methods:

A multicenter retrospective analysis of NHL pts ≥80 years diagnosed between (1999–2009) was completed. Detailed characteristics obtained include geriatric syndromes (GS), activities of daily living (ADLs), and co-morbidities using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G). Further, univariate associations with survival were determined, while a multivariate Cox regression proportional hazards model was performed.

Results:

We identified 303 pts: 170 aggressive NHL (84% B-cell and 16% T-cell) and 133 indolent NHL (82% B-cell and 18% T-cell). Median age was 84 years (range 80–95). Poor performance status (PS), high LDH, and extranodal disease were more common in aggressive vs. indolent NHLs (P=0.004, 0.005, and 0.002, respectively). Furthermore, aggressive NHL pts presented more frequently with advanced stage and higher relative prognostic scores (P=0.0002 and 0.003 respectively). Loss of any ADL was more frequent in aggressive histology (P=0.002). Diffuse large B-cell NHL was the most common histology overall, while follicular lymphoma was the most diagnosed indolent NHL. At least one GS was present in 80 pts (26%) with dementia being most common (26%). Loss of at least one ADL was seen in 14%, while 30% of pts were considered “non-fit” at diagnosis. Of available treatment data in aggressive B-NHL, 62% received rituximab (R)-containing regimen and 18% received chemotherapy without R. Those with aggressive T-cell NHL were treated with systemic therapy in 74%, topical in 15%, radiation in 4%, and no therapy in 7%. Indolent B-cell NHL had observation in 38% for a median of 26 months, R alone in 21%, R plus chemotherapy in 15%, radiation alone in 7%, and chemotherapy alone in 9%. Cutaneous T-cell pts received topical therapies in 42%, systemic therapy in 29%, and radiation alone in 17%. At 49-month median follow-up, 4-year progression-free (PFS) and overall survival (OS) for aggressive NHL were 31% and 44%, respectively (stage I/II: PFS 53% and OS 66%; stage III/IV: PFS 20% and OS 32%; p<0.0001 and 0.0002, respectively). Four-year PFS and OS for indolent NHL were 44% and 66%, respectively, regardless of stage. Prognostic factors predicting OS and PFS on univariate are detailed in Table 1. Cox multivariate regression analysis identified two factors predicting inferior outcome for both NHL groups: lack of complete response (CR) (indolent: PFS, P=0.03; OS, P=0.01; aggressive: PFS, P<0.0001; OS, P<0.0002) and loss of ADLs (indolent: PFS, P=0.003; OS, P=0.0004; aggressive: PFS, P=0.002; OS, P<0.0001).

Table 1.

Prognostic factors associated with survival (univariate analysis)

Aggressive NHL
PFSOS
HR95% CIPHR*95% CIP
ECOG PS 2-4 1.69 (1.12, 2.56) 0.01 2.35 (1.48, 3.73) 0.0003 
Any CIRS score 4 1.42 (0.91, 2.22) 0.12 1.99 (1.24, 3.19) 0.004 
Loss of any ADL 2.89 (1.86, 4.50) <0.0001 3.57 (2.53, 5.66) <0.0001 
Any geriatric syndrome 1.31 (0.88, 1.96) 0.18 1.77 (1.17, 2.69) 0.007 
Elevated creatinine 1.51 (0.99, 2.30) 0.053 1.67 (1.08, 2.58) 0.02 
Elevated LDH 1.55 (1.05, 2.27) 0.03 1.68 (1.10, 2.57) 0.02 
Hypoalbuminemia 1.15 (0.99, 1.34) 0.07 1.35 (1.15, 1.58) 0.0003 
Stage III/IV 2.40 (1.54, 3.74) 0.0001 2.49 (1.52, 4.08) 0.0003 
Marrow involvement 1.93 (1.22, 3.06) 0.005 1.60 (0.98, 2.61) 0.06 
↑ IPI or FLIPI 1.91 (1.26, 2.90) 0.002 2.26 (1.43, 3.57) 0.0005 
Response: no CR 2.88 (1.91, 4.32) <0.0001 2.35 (1.51, 3.67) 0.0002 
Aggressive NHL
PFSOS
HR95% CIPHR*95% CIP
ECOG PS 2-4 1.69 (1.12, 2.56) 0.01 2.35 (1.48, 3.73) 0.0003 
Any CIRS score 4 1.42 (0.91, 2.22) 0.12 1.99 (1.24, 3.19) 0.004 
Loss of any ADL 2.89 (1.86, 4.50) <0.0001 3.57 (2.53, 5.66) <0.0001 
Any geriatric syndrome 1.31 (0.88, 1.96) 0.18 1.77 (1.17, 2.69) 0.007 
Elevated creatinine 1.51 (0.99, 2.30) 0.053 1.67 (1.08, 2.58) 0.02 
Elevated LDH 1.55 (1.05, 2.27) 0.03 1.68 (1.10, 2.57) 0.02 
Hypoalbuminemia 1.15 (0.99, 1.34) 0.07 1.35 (1.15, 1.58) 0.0003 
Stage III/IV 2.40 (1.54, 3.74) 0.0001 2.49 (1.52, 4.08) 0.0003 
Marrow involvement 1.93 (1.22, 3.06) 0.005 1.60 (0.98, 2.61) 0.06 
↑ IPI or FLIPI 1.91 (1.26, 2.90) 0.002 2.26 (1.43, 3.57) 0.0005 
Response: no CR 2.88 (1.91, 4.32) <0.0001 2.35 (1.51, 3.67) 0.0002 
Indolent NHL
PFSOS
HR*95% CIPHR*95% CIP
Loss of any ADL 3.58 (1.61, 7.96) 0.002 5.56 (2.27, 13.61) 0.0002 
Any geriatric syndrome 1.86 (1.13, 3.05) 0.01 1.69 (0.97, 2.94) 0.06 
B symptoms 1.34 (0.64, 2.81) 0.45 2.11 (0.98, 4.54) 0.055 
Weight loss >10% 1.28 (0.67, 2.48) 0.45 2.81 (1.43, 5.52) 0.003 
ECOG PS 2-4 1.14 (0.84, 1.54) 0.40 1.36 (1.01, 1.83) 0.045 
Response: no CR 2.19 (1.18, 4.05) 0.01 2.91 (1.37, 6.20) 0.006 
Indolent NHL
PFSOS
HR*95% CIPHR*95% CIP
Loss of any ADL 3.58 (1.61, 7.96) 0.002 5.56 (2.27, 13.61) 0.0002 
Any geriatric syndrome 1.86 (1.13, 3.05) 0.01 1.69 (0.97, 2.94) 0.06 
B symptoms 1.34 (0.64, 2.81) 0.45 2.11 (0.98, 4.54) 0.055 
Weight loss >10% 1.28 (0.67, 2.48) 0.45 2.81 (1.43, 5.52) 0.003 
ECOG PS 2-4 1.14 (0.84, 1.54) 0.40 1.36 (1.01, 1.83) 0.045 
Response: no CR 2.19 (1.18, 4.05) 0.01 2.91 (1.37, 6.20) 0.006 
Conclusion:

To our knowledge, this represents the largest analysis of very elderly NHL reported to date. We identified that loss of ADL's and lack of CR to initial treatment were robust predictors of survival in very elderly NHL, irrespective of histology, and they superseded the prognostic value of either PS or age. Geriatric assessments, including ADLs, are powerful predictors of outcome in very elderly NHL and should be prospectively studied.

Disclosures:

No relevant conflicts of interest to declare.

Author notes

*

Asterisk with author names denotes non-ASH members.