What is the prognosis of Non-Hodgkin's Lymphoma (NHL) in a 75-year-old female?

From the Guidelines

The prognosis for a 75-year-old woman with non-Hodgkin's lymphoma (NHL) is significantly influenced by factors such as the specific NHL subtype, disease stage, presence of B symptoms, overall health status, and the International Prognostic Index (IPI) score, with 5-year survival rates ranging from 40-80% depending on these factors 1.

Key Determinants of Prognosis

The most important determinants of prognosis in this patient include:

• The specific NHL subtype (such as diffuse large B-cell lymphoma, follicular lymphoma, or mantle cell lymphoma)
• Disease stage at diagnosis
• Presence of B symptoms (fever, night sweats, weight loss)
• Overall health status
• The International Prognostic Index (IPI) score

Treatment Approaches

Treatment approaches for elderly patients with NHL are often adjusted to account for comorbidities and functional status, and may include:

• R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) with possible dose modifications
• Less intensive regimens like R-mini-CHOP or R-CEOP (substituting etoposide for doxorubicin)

Importance of Geriatric Assessment

Comprehensive geriatric assessment is crucial in guiding treatment decisions for elderly patients with NHL, as it can help identify patients who are at high risk of treatment-related toxicity and mortality 1. The use of a geriatric assessment, such as the G8 questionnaire, can help tailor treatment choice and intensity to individual patients 1.

Prognostic Factors

Age itself is a prognostic factor, with increasing age associated with a higher prevalence of comorbidities, functional decline, cognitive impairment, depressive mood, and dependence in activities of daily living (ADL) 1. However, many older patients can achieve remission with appropriate therapy tailored to their specific condition and functional status.

From the FDA Drug Label

Among patients with DLBCL evaluated in three randomized, active-controlled trials, 927 patients received RITUXAN in combination with chemotherapy. Of these, 396 (43%) were age 65 or greater and 123 (13%) were age 75 or greater. No overall differences in effectiveness were observed between these patients and younger patients Patients with previously untreated follicular NHL evaluated in NHL Study 5 were randomized to RITUXAN as single-agent maintenance therapy (n=505) or observation (n=513) after achieving a response to RITUXAN in combination with chemotherapy. Of these, 123 (24%) patients in the RITUXAN arm were age 65 or older No overall differences in safety or effectiveness were observed between these patients and younger patients.

The prognosis of Non-Hodgkin's Lymphoma (NHL) in a 75-year-old female cannot be directly determined from the provided information, as the data does not specifically address the prognosis for a 75-year-old female patient. However, it is noted that:

• No overall differences in effectiveness were observed between patients 75 years or older and younger patients in the treatment of DLBCL.
• No overall differences in safety or effectiveness were observed between patients 65 years or older and younger patients in the treatment of follicular NHL. It is essential to consider that the incidence of adverse reactions was higher among older patients, particularly those 70 years or older, in other studies 2.

From the Research

Prognosis of Non-Hodgkin's Lymphoma (NHL) in a 75-year-old female

• The prognosis of NHL in a 75-year-old female depends on various factors, including the type of lymphoma, stage of disease, and overall health of the patient 3, 4, 5, 6, 7.
• Studies have shown that older patients with NHL have increased risk of therapy-related toxicity due to age-related physiological changes and frequent co-morbidities 3.
• A functional assessment of the elderly patient is necessary to determine the likelihood of tolerating and responding to therapy, and the comprehensive geriatric assessment (CGA) is a useful tool in this regard 3.
• The use of rituximab, a monoclonal antibody, has improved survival in patients with NHL, and is often used in combination with chemotherapy 3, 4.
• In very elderly patients (aged ≥ 75 years) with diffuse large B-cell lymphoma, treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) can be beneficial but is often associated with severe treatment-related toxicity 4.
• The overall survival of patients with NHL aged 70 years and older has been reported to be around 38-57% at 5 years, depending on the stage and grade of the disease 5.
• In patients over 80 years old, the median overall survival has been reported to be around 2.2 years, with disease progression being the main reason for death 6.
• Age alone should not be a contraindication to treatment, and a high response rate can be achieved in very elderly NHL patients despite aggressive histology and poor prognostic features 7.

Factors Affecting Prognosis

• Stage of disease: advanced stage disease is associated with poorer outcomes 3, 5.
• Grade of disease: high-grade disease is associated with poorer outcomes 5.
• Performance status: poor performance status is associated with poorer outcomes 6.
• Co-morbidities: while common in elderly patients, co-morbidities do not necessarily affect survival 6.
• Treatment: the use of rituximab and chemotherapy can improve survival, but is often associated with toxicity 3, 4.