The probability of developing non- Hodgkin lymphoma ( NHL ) increases with age . Thus , as the U . S . population ages , a greater number of patients are at risk for acquiring NHL . This includes diffuse large B-cell lymphoma ( DLBCL ) – a disease with a mean age at diagnosis of 70 years . People > 80 years old now comprise more than one-quarter of those ≥65 years old , but , because of their multiple comorbidities , poor performance status , and concerns about chemotherapyinduced toxicities , are rarely included in clinical trials of DLBCL .

Unfortunately , that has led to a lack of consensus regarding treatment in this population , according to Upama Giri , MD , and Michael G . Martin , MD , both from the University of Tennessee Health Science Center in Memphis , who published a research letter in Blood Advances analyzing survival outcomes in patients who were ≥80 years old at the time of DLBCL diagnosis .

Drs . Giri and Martin conducted a population-based study of data from the National Cancer Institute ’ s Surveillance , Epidemiology , and End Results ( SEER ) database , identifying 14,386 cases diagnosed with DLBCL between 1983 and 2013 .

The data were split into three cohorts :

• cohort 1 : cases diagnosed between 1983 and 1996 ( n = 2,578 )

• cohort 2 : cases diagnosed between 1997 and 2005 ( n = 5,131 )

• cohort 3 : cases diagnosed between 2006 and 2013 ( n = 6,677 )

“ These study periods were selected since rituximab was approved for treatment of relapsed or refractory , low‐grade or follicular , B‐cell NHL in 1997 , and its approval was extended to treatment of DLBCL in 2006 ,” the authors explained .

Each cohort was further divided into two groups : Group A included patients 80-89 years old and group B included patients ≥90 years old .

The authors measured overall survival ( OS ; calculated as the time from diagnosis until death from any cause or date of last follow‐up ) and diseasespecific survival ( DSS ; calculated as the time from diagnosis until death from DLBCL or date of last follow‐up ) at 24 months .

OS and DSS for both groups and for all survival periods increased over time ; this survival increase was markedly higher for patients in group A than in group B . In group A , rates of 6- , 12- , and 24-month OS and DSS increased significantly over time ( p < 0.005 and p = 0.04 ). In group B , rates of 12- and 24-month OS increased significantly over time , but

there was no significant difference in DSS over time ( p value not provided ). See the TABLE for rates of OS and DSS at various timepoints .

Multivariate analyses identified several factors associated with survival :

• hazard ratio ( HR ) for year of diagnosis = 0.87 for cohort 2 vs . cohort 1 ( 95 % CI 0.811‐0.926 ; p < 0.005 ) and 0.76 for cohort 3 vs . cohort 1 ( 95 % CI 0.710‐0.808 ; p < 0.005 ), meaning survival improved in latter years .

• HR for increasing age at diagnosis = 1.43 for group B vs . group A ( 95 % CI 1.334‐1.529 ; p < 0.005 ), meaning survival was better for younger patients .

• HR for Ann Arbor stage = 1.27 ( 95 % CI 1.241‐1.292 ; p < 0.005 ), indicating worse survival for higher-stage disease .

Drs . Giri and Martin provided several possible explanations for this improved survival , including the introduction of rituximab , better control of comorbidities , and improved performance status in older patients . All of these factors “ could have contributed to more physicians and patients willing to proceed with treatment and this improvement in survival ,” they noted . “ More prospective studies are needed in the very old patient population , taking into consideration the comorbidities associated with these age groups to clearly define guidelines for management of DLBCL in this population ,” the authors concluded .

The study ’ s findings were limited by the nature of SEER data , since information regarding comorbidities and modalities of treatment are not available . ●

REFERENCE

Giri U , Martin MG . Survival outcomes in the very elderly with DLBCL prior to and after the introduction of rituximab : a US population-based study . Blood Adv . 2017 ; 1:615-8 .