NON-HODGKINS-LYMPHOMA IN THE OLDER PERSON - A REVIEW

Objective: To study the epidemiology of non-Hodgkin's Lymphoma (NHL) in the older person and to explore treatment strategies for older persons with NHL. Design: Review of the English literature. Measurements: Incidence of NHL in patients of different ages; prevalence of NHL of different grades and stages in persons of different ages; and response to treatment, disease free survival, and survival, for patients of different ages. Results: The incidence of NHL in the aged has increased approximately 80% since 1970, and approximately one-half of the 40,000 annual new cases occur in persons aged 60 and older in the USA. The 2-4 phenoxy pesticides may be partly responsible for this increment. The treatment of low grade lymphoma is mostly palliative and well tolerated by the aged. Age may have an adverse effect on the prognosis of intermediate grade lymphomas, and the prevalence of poor prognostic factors and comorbidity increases with age. Among persons aged 65-75, the complete response rate (CRR) of intermediate grade NHL to chemotherapy is approximately 50%, and approximately one-third of complete responders remain alive and free of disease 5 years from diagnosis. Among those aged 75 and older, the CRR to chemotherapy is approximately 40%, and the median duration of response is 16 months. Strategies aimed to ameliorate treatment-related toxicity include lower doses of chemotherapy, choice of drugs better tolerated by older individuals, and prevention of chemotherapy-induced toxicity. Conclusions: NHL are an increasingly common problem for older persons. Approximately 80% of older patients with low grade lymphomas and 40%-50% of those with intermediate grade lymphomas may benefit from chemotherapy. Individualized treatment, based on life expectancy and comorbidity, is the key to effective management.