A retrospective study on 73 elderly patients (≥75years) with aggressive B-cell non Hodgkin lymphoma: Clinical significance of treatment intensity and comprehensive geriatric assessment

Francesco Marchesi, Natalia Cenfra, Lidia Altomare, Maria L. Dessanti, Sergio Mecarocci, Elisabetta Cerchiara, Angela Rago, Mariella D'Andrea, Valeria Tomarchio, Odoardo M. Olimpieri, Maria C. Tirindelli, Andrea Mengarelli, Maria C. Petti, Guiseppe Avvisati, Guiseppe Cimino

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Abstract

ObjectiveThe clinical outcome of elderly (≥ 75. years) patients with aggressive B-cell non-Hodgkin lymphoma (B-NHL) is not firmly established because few studies have specifically addressed this issue. In addition, the usefulness of a comprehensive geriatric assessment (CGA) in B-NHL still needs to be deeply explored. Materials and MethodsWe evaluated the prognostic factors of 73 patients aged ≥ 75. years (median age: 78) with B-NHL treated by clinical judgment with curative anthracycline-based approaches (n = 36) or with conservative treatments without anthracyclines (n = 37). Analysis of clinical outcomes also included baseline CGA stratification. ResultsThe curative approaches resulted in a better clinical outcome than conservative approaches [overall response rate: 91.2% vs. 69.7%, P = 0.003; 2-year progression-free survival: 47.2% vs. 21.6%, P = 0.006; and 2-year overall survival (OS): 58.3% vs 24.3%, P = 0.003] with similar safety profiles. Independent of treatment type, patients classified as "fit" and "intermediate" by CGA presented with better OS compared to patients classified as "frail" (P <0.001). Patients classified as "fit" and "intermediate" who were receiving curative treatments presented with a significantly better OS when compared with those treated conservatively on the basis of clinical judgment. A curative anthracycline-based therapy (P = 0.048), the response to treatment (P = 0.017) and a "frail" condition (P = 0.031) were the only factors affecting OS in multivariate analysis. ConclusionsPresent data indicates that even in elderly patients with B-NHL curative anthracycline-based therapies are more effective than conservative approaches. However, choice of treatment should rely more on objective than on subjective parameters. Therefore, further prospective trials are warranted to better define the CGA role in hematopoietic malignancies.

Original languageEnglish
Pages (from-to)242-248
Number of pages7
JournalJournal of Geriatric Oncology
Volume4
Issue number3
DOIs
Publication statusPublished - Jul 2013

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Keywords

  • Aggressive B-cell non-Hodgkin lymphoma
  • Anthracyclines-based chemotherapy
  • Comprehensive geriatric assessment
  • Conservative regimens without anthracyclines
  • Very elderly patients

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Oncology

Cite this

Marchesi, F., Cenfra, N., Altomare, L., Dessanti, M. L., Mecarocci, S., Cerchiara, E., Rago, A., D'Andrea, M., Tomarchio, V., Olimpieri, O. M., Tirindelli, M. C., Mengarelli, A., Petti, M. C., Avvisati, G., & Cimino, G. (2013). A retrospective study on 73 elderly patients (≥75years) with aggressive B-cell non Hodgkin lymphoma: Clinical significance of treatment intensity and comprehensive geriatric assessment. Journal of Geriatric Oncology, 4(3), 242-248. https://doi.org/10.1016/j.jgo.2013.04.003