From the Guidelines
Age is a significant risk factor for non-Hodgkin lymphoma (NHL), with incidence rates increasing steadily as people get older, and the median age of diagnosis is around 67 years, as reported in a study published in the Annals of Oncology 1. The relationship between age and non-Hodgkin lymphoma is complex, involving multiple factors that contribute to the increased risk of developing the disease. Some key points to consider include:
- The immune system naturally weakens with age, reducing its ability to surveil and eliminate abnormal cells, allowing malignant lymphocytes to proliferate unchecked 1.
- DNA damage accumulates over time due to lifelong exposure to environmental toxins, radiation, and other carcinogens, increasing the likelihood of cancer-causing mutations in lymphocytes.
- Older individuals have experienced more cumulative exposure to potential risk factors like certain infections, which can trigger lymphoma development.
- The body's DNA repair mechanisms become less efficient with age, making it harder to correct genetic errors that could lead to cancer. As noted in the study by the International Society of Geriatric Oncology (SIOG) expert position commentary, published in 2015 1, the incidence of NHL has been increasing up to 8–10% per year, with the greatest increases in patients over 60 years old. Key factors to consider when evaluating the relationship between age and non-Hodgkin lymphoma include:
- The most common subtype of NHL in the elderly is diffuse large B-cell NHL (DLBCL) 1.
- Treatment with anthracycline-based chemotherapy is complicated by comorbidities and alterations in functional status in older adults 1.
- Prospective clinical treatment trials in older DLBCL patients have resulted in significant therapeutic advances in the past decade 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Age and Non-Hodgkin's Lymphoma
- Age is known to have an important influence on survival in non-Hodgkin's lymphoma (NHL) 2
- Survival curves for 5-year age groups up to and including age 60-64 years were similar, after which a major effect of age upon survival was apparent 2
- Older patients had a lower response rate to initial therapy and salvage treatments 2
- Prognostic variables differ between younger and older patients with NHL, with age, histology, LDH elevation, and gender being less important in younger patients 2
Risk Factors for Non-Hodgkin's Lymphoma
- A history of adult-onset diabetes mellitus was associated with an increased risk of developing NHL 3
- A history of blood transfusion was also at increased risk for the development of NHL 3
- History of a previous cancer (excluding hematopoietic and lymphatic cancers) was associated with an increased risk of NHL 3
Treatment of Non-Hodgkin's Lymphoma
- Rituximab, an anti-CD20 monoclonal antibody, has demonstrated efficacy in patients with various lymphoid malignancies, including indolent and aggressive forms of B-cell non-Hodgkin's lymphoma (NHL) 4
- Rituximab in combination with CHOP chemotherapy has emerged as a new treatment standard for previously untreated diffuse large B-cell lymphoma, at least in elderly patients 4
- Emerging immune and cell therapies, including checkpoint inhibitors, bispecific antibodies, and chimeric antigen receptor T-cell therapy, are being investigated for the treatment of relapsed/refractory NHL 5, 6