A Look at Lymphoid Neoplasms in Patients over 65: Are We Less Aggressive - and Does It Affect Outcome?

BACKGROUND

With a greater proportion of the general population continuing to age from advancements in scientific knowledge, more patients newly diagnosed with malignant lymphoid tumors are elderly (age > 70). Geriatric oncology continues to face challenges in the management of these conditions because of co-morbid conditions, and therapy tolerance limitations associated with aging. Research has shown that geriatric patients get less chemotherapy than non-geriatric counterparts. The main objective of this study was to analyze outcomes of elderly patients (age>65) diagnosed with Hodgkin and Non Hodgkin lymphoma and the relation to several variables including HIV status, financial status and ethnicity.

METHODS

We identified and included elderly patients (age >65) diagnosed with any subtype lymphoma by using ICD-9 and ICD-10 codes. The patients identified received care exclusively with Mays Cancer Center at UT Health San Antonio between 1998-2017. Variables for each patient measured included age, gender, diagnosis, stage, > 2 comorbidities, vitality status, HIV status, insurance status, treatment received, and treatment response. Dates of treatment and type of treatment was confirmed by documentation or chemotherapy orders, and diagnosis was confirmed by original pathology report. The statistical significance of associations with treatment response was assessed with Pearson's Chi-Square, Fisher's Exact test, and a logistic regression model with a generalized logit link with a 3-level response (CR, PR, F) where CR was designated as the referent. For each effect, the Odds Ratio (OR) and its 95% confidence interval (95% CI) are reported. All statistical testing was two-sided with a significance level of 5%. SAS Version 9.4 for Windows (SAS Institute, Cary NC) was used throughout.

RESULTS

Our patient population (n=346) was shown to have a median of 56, female patients (n=174, 50.3%), males patients (n=172, 49.7%), Hispanics (n=180, 52%), uninsured (n=107, 30.9%), and HIV (n=22, 6%). Diagnoses studied included aggressive lymphomas (Burkitt's, 1ry CNS, Hodgkin's, NHL, PTLD; n=252) and indolent lymphomas (Marginal Zone, Follicular; n=94). The odds of treatment failure (F) and of Partial Response (PR) in patients >65 was significantly increased relative to the odds in those ≤65 (F OR=1.04, 95% CI 1.01 to 1.07, p=0.02, PR OR=1.03, 95% CI 1 to 1.05, p=0.032). In an examination of variation in the relation between treatment response and treatment (chemo, chemo/immunotherapy, immune therapy alone, others) with age, we found no overall association between treatment response and treatment after adjustment for age (p=0.92) and no association between treatment response and treatment among those ≤65 or >65 (p=0.54 and p=0.97) respectively.

CONCLUSION

Hematologic malignancies are potentially curable or may have long lasting remission with current available treatment options; however, age with concurrent declining functional status can preclude many therapies. In our patient population, age did not preclude aggressive treatment with intent for cure.