OUTCOMES OF INDOLENT LYMPHOMAS (INHL) IN THE ELDERLY - AN OBSERVATIONAL STUDY OF KROHEM, THE CROATIAN COOPERATIVE GROUP FOR HEMATOLOGICAL DISEASES
(Abstract release date: 05/19/16)
EHA Library. Dujmovic D. 06/09/16; 134768; PB1868
Dr. Dino Dujmovic
Contributions
Contributions
Abstract
Abstract: PB1868
Type: Publication Only
Background
New treatment approaches have improved outcomes in patients with indolent NHL. However, only limited data exist on outcomes of elderly patients.
Aims
We performed this observational study to analyse disease characteristics, treatment patterns, outcomes and prognosis of elderly patients with indolent B-NHL
Methods
Data were generated from a country-wide observational study of patients treated with rituximab in 2007 and 2008 and from the KroHem Lymphoma registry.Only those receiving front-line treatment were included; watch-and-wait patients were excluded.
Results
We identified 172 patients older than 60 years. Median age was 72, the oldest treated patient was 95 years old; 58% were women. 82 patients had follicular lymphoma (FL), 59 marginal zone lymphomas (MZL), 16 small lymphocytic lymphoma (SLL) and 15 lymphoplasmacytic lymphoma (LPL). Median follow-up of the whole cohort was 44 months. Most patients received R-CHOP (45%) or R-CVP (39%). Selected patients with stage 1 disease were treated with radiotherapy only and those with splenic lymphomas with surgery. Only 22 received rituximab maintenance.5-year overall survival (OS) was 61% and progression-free survival (PFS) 46%. Extranodal MZL had best OS and PFS (72% and 66% at 5y respectively). FL had better OS but not PFS (64% and 42% at 5y respectively) than non-FL iNHL. Nodal MZL, SLL and LPL had similar outcomes (OS at 5y 53%, 48% and 47%; PFS at 5y 44%, 38% and 33%, respectively). Best outcomes were seen in the group of patients amenable to local therapy: surgery or irradiation.R-CHOP did not improve OS in comparison to R-CVP but there was a trend to better PFS, especially in patients with FL (p=0.07). When compared to younger patients registered in the observational study, patients older than 60 had somewhat inferior OS and PFS, but the difference in outcomes between those younger and older than 75 was striking (p<0.0001) (Fig).All types of deaths were more frequent in the very elderly, but deaths during treatment especially so; 22% of deaths in the group between 60 and 75 occurred during front-line treatment in comparison to 37% in those above 75. In contrast, 58% of deaths in those between 60 and 75 occurred after relapse in comparison to only 37% in the older group.
Conclusion
It seems that the prognostic influence of iNHL types has remained unchanged from the pre-rituximab era with extranodal MZL having the best prognosis, followed by FL. Patients with stage one disease have an excellent outcome. The impact of anthracyclines seems limited. Currently used regimens are too toxic or not effective enough in patients older than 75. In this group of patients new treatment approaches are needed that would reduce mortality during front-line treatment without compromising efficacy.
Session topic: E-poster
Keyword(s): Elderly, Non-Hodgkin's lymphoma, Rituximab, Therapy
Type: Publication Only
Background
New treatment approaches have improved outcomes in patients with indolent NHL. However, only limited data exist on outcomes of elderly patients.
Aims
We performed this observational study to analyse disease characteristics, treatment patterns, outcomes and prognosis of elderly patients with indolent B-NHL
Methods
Data were generated from a country-wide observational study of patients treated with rituximab in 2007 and 2008 and from the KroHem Lymphoma registry.Only those receiving front-line treatment were included; watch-and-wait patients were excluded.
Results
We identified 172 patients older than 60 years. Median age was 72, the oldest treated patient was 95 years old; 58% were women. 82 patients had follicular lymphoma (FL), 59 marginal zone lymphomas (MZL), 16 small lymphocytic lymphoma (SLL) and 15 lymphoplasmacytic lymphoma (LPL). Median follow-up of the whole cohort was 44 months. Most patients received R-CHOP (45%) or R-CVP (39%). Selected patients with stage 1 disease were treated with radiotherapy only and those with splenic lymphomas with surgery. Only 22 received rituximab maintenance.5-year overall survival (OS) was 61% and progression-free survival (PFS) 46%. Extranodal MZL had best OS and PFS (72% and 66% at 5y respectively). FL had better OS but not PFS (64% and 42% at 5y respectively) than non-FL iNHL. Nodal MZL, SLL and LPL had similar outcomes (OS at 5y 53%, 48% and 47%; PFS at 5y 44%, 38% and 33%, respectively). Best outcomes were seen in the group of patients amenable to local therapy: surgery or irradiation.R-CHOP did not improve OS in comparison to R-CVP but there was a trend to better PFS, especially in patients with FL (p=0.07). When compared to younger patients registered in the observational study, patients older than 60 had somewhat inferior OS and PFS, but the difference in outcomes between those younger and older than 75 was striking (p<0.0001) (Fig).All types of deaths were more frequent in the very elderly, but deaths during treatment especially so; 22% of deaths in the group between 60 and 75 occurred during front-line treatment in comparison to 37% in those above 75. In contrast, 58% of deaths in those between 60 and 75 occurred after relapse in comparison to only 37% in the older group.
Conclusion
It seems that the prognostic influence of iNHL types has remained unchanged from the pre-rituximab era with extranodal MZL having the best prognosis, followed by FL. Patients with stage one disease have an excellent outcome. The impact of anthracyclines seems limited. Currently used regimens are too toxic or not effective enough in patients older than 75. In this group of patients new treatment approaches are needed that would reduce mortality during front-line treatment without compromising efficacy.
Session topic: E-poster
Keyword(s): Elderly, Non-Hodgkin's lymphoma, Rituximab, Therapy
Abstract: PB1868
Type: Publication Only
Background
New treatment approaches have improved outcomes in patients with indolent NHL. However, only limited data exist on outcomes of elderly patients.
Aims
We performed this observational study to analyse disease characteristics, treatment patterns, outcomes and prognosis of elderly patients with indolent B-NHL
Methods
Data were generated from a country-wide observational study of patients treated with rituximab in 2007 and 2008 and from the KroHem Lymphoma registry.Only those receiving front-line treatment were included; watch-and-wait patients were excluded.
Results
We identified 172 patients older than 60 years. Median age was 72, the oldest treated patient was 95 years old; 58% were women. 82 patients had follicular lymphoma (FL), 59 marginal zone lymphomas (MZL), 16 small lymphocytic lymphoma (SLL) and 15 lymphoplasmacytic lymphoma (LPL). Median follow-up of the whole cohort was 44 months. Most patients received R-CHOP (45%) or R-CVP (39%). Selected patients with stage 1 disease were treated with radiotherapy only and those with splenic lymphomas with surgery. Only 22 received rituximab maintenance.5-year overall survival (OS) was 61% and progression-free survival (PFS) 46%. Extranodal MZL had best OS and PFS (72% and 66% at 5y respectively). FL had better OS but not PFS (64% and 42% at 5y respectively) than non-FL iNHL. Nodal MZL, SLL and LPL had similar outcomes (OS at 5y 53%, 48% and 47%; PFS at 5y 44%, 38% and 33%, respectively). Best outcomes were seen in the group of patients amenable to local therapy: surgery or irradiation.R-CHOP did not improve OS in comparison to R-CVP but there was a trend to better PFS, especially in patients with FL (p=0.07). When compared to younger patients registered in the observational study, patients older than 60 had somewhat inferior OS and PFS, but the difference in outcomes between those younger and older than 75 was striking (p<0.0001) (Fig).All types of deaths were more frequent in the very elderly, but deaths during treatment especially so; 22% of deaths in the group between 60 and 75 occurred during front-line treatment in comparison to 37% in those above 75. In contrast, 58% of deaths in those between 60 and 75 occurred after relapse in comparison to only 37% in the older group.
Conclusion
It seems that the prognostic influence of iNHL types has remained unchanged from the pre-rituximab era with extranodal MZL having the best prognosis, followed by FL. Patients with stage one disease have an excellent outcome. The impact of anthracyclines seems limited. Currently used regimens are too toxic or not effective enough in patients older than 75. In this group of patients new treatment approaches are needed that would reduce mortality during front-line treatment without compromising efficacy.
Session topic: E-poster
Keyword(s): Elderly, Non-Hodgkin's lymphoma, Rituximab, Therapy
Type: Publication Only
Background
New treatment approaches have improved outcomes in patients with indolent NHL. However, only limited data exist on outcomes of elderly patients.
Aims
We performed this observational study to analyse disease characteristics, treatment patterns, outcomes and prognosis of elderly patients with indolent B-NHL
Methods
Data were generated from a country-wide observational study of patients treated with rituximab in 2007 and 2008 and from the KroHem Lymphoma registry.Only those receiving front-line treatment were included; watch-and-wait patients were excluded.
Results
We identified 172 patients older than 60 years. Median age was 72, the oldest treated patient was 95 years old; 58% were women. 82 patients had follicular lymphoma (FL), 59 marginal zone lymphomas (MZL), 16 small lymphocytic lymphoma (SLL) and 15 lymphoplasmacytic lymphoma (LPL). Median follow-up of the whole cohort was 44 months. Most patients received R-CHOP (45%) or R-CVP (39%). Selected patients with stage 1 disease were treated with radiotherapy only and those with splenic lymphomas with surgery. Only 22 received rituximab maintenance.5-year overall survival (OS) was 61% and progression-free survival (PFS) 46%. Extranodal MZL had best OS and PFS (72% and 66% at 5y respectively). FL had better OS but not PFS (64% and 42% at 5y respectively) than non-FL iNHL. Nodal MZL, SLL and LPL had similar outcomes (OS at 5y 53%, 48% and 47%; PFS at 5y 44%, 38% and 33%, respectively). Best outcomes were seen in the group of patients amenable to local therapy: surgery or irradiation.R-CHOP did not improve OS in comparison to R-CVP but there was a trend to better PFS, especially in patients with FL (p=0.07). When compared to younger patients registered in the observational study, patients older than 60 had somewhat inferior OS and PFS, but the difference in outcomes between those younger and older than 75 was striking (p<0.0001) (Fig).All types of deaths were more frequent in the very elderly, but deaths during treatment especially so; 22% of deaths in the group between 60 and 75 occurred during front-line treatment in comparison to 37% in those above 75. In contrast, 58% of deaths in those between 60 and 75 occurred after relapse in comparison to only 37% in the older group.
Conclusion
It seems that the prognostic influence of iNHL types has remained unchanged from the pre-rituximab era with extranodal MZL having the best prognosis, followed by FL. Patients with stage one disease have an excellent outcome. The impact of anthracyclines seems limited. Currently used regimens are too toxic or not effective enough in patients older than 75. In this group of patients new treatment approaches are needed that would reduce mortality during front-line treatment without compromising efficacy.
Session topic: E-poster
Keyword(s): Elderly, Non-Hodgkin's lymphoma, Rituximab, Therapy
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