The survival gain of treated elderly patients with non-Hodgkin lymphoma is comparable to that of younger patients. That is one of the findings of Dr Djamila Issa (VU/Jeroen Bosch Hospital) in her dissertation, which was published earlier this year. Although the overall survival of elderly patients with non-Hodgkin lymphoma lags behind compared to younger patients, this difference in survival gain almost completely disappears when only treated elderly patients are considered. Issa wants to champion the treatment of elderly patients.
In her dissertation earlier this year, Issa sets out the epidemiology of non-Hodgkin’s lymphomas in general and of a number of specific lymphomas. She also discusses the treatments of various non-Hodgkin lymphomas. To this end, Issa conducted population-based research based on data from the Dutch Cancer Registry (NKR) and PHAROS data on treatment in non-Hodgkin’s lymphomas. She also used PROFILES data on quality of life. Population-based research is a nice addition to clinical studies, says Issa, because it includes all patients.
‘Clinical studies involve a certain selection of patients. For example, patients with comorbidities are often not allowed to participate,’ explains Issa. There will be more studies on the elderly patient, but initially these often involved patients up to 80 years of age. ‘The great thing about population-based studies is that you can analyze the entire group. Then you can compare results nicely.’ This also applies to rarer conditions. ‘It is more difficult to do clinical studies for really rare malignancies, such as Burkitt’s lymphoma. Then population-based research is also a solution.’
Fewer courses of R-CHOP just as effective
The diffuse large B-cell lymphoma (DLBCL) is one of the diseases in which Issa studied the treatment; in this case she compared the R-CHOP14 regimen (R-CHOP course once every two weeks) with the R-CHOP21 regimen (R-CHOP course once every three weeks) and compared giving 6 courses giving 8 cures. These schedules are used as treatment in stage II-IV DLBCL. ‘There was no difference in survival between the two schedules and both number of courses,’ Issa says.
And that while the R-CHOP14 schedule produced more polyneuropathy (tingling and/or numbness in extremities). Issa also compared both schedules of courses and both numbers for patients aged 18 to 64 years. ‘Here too there was no difference in survival. Patients can therefore be treated just as effectively with fewer side effects,’ says Issa. ‘In response to these findings, among other things, the guideline has been amended in the Netherlands.’
There really is a case for making sure that we can also treat that older group of patients
Survival gain in elderly patient being treated
It appears that survival has improved for many non-Hodgkin lymphomas, especially in younger patients, but Issa, for example, calls “the overall outcome of patients with DLBCL over 80 years of age unsatisfactory despite recent improvements.” A striking finding that Issa makes about survival is that in patients older than 75 years with an aggressive non-Hodgkin lymphoma, survival increased less rapidly than in patients younger than 75. ‘But when patients older than 75 who did not receive treatment were excluded from the treatment. analysis, it appears that the increase in survival of this patient group was comparable to that of younger patients,’ says Issa.
‘There is really a case for making sure that we can also treat this older group of patients,’ says Issa. ‘They can’t be heavy treatments, of course, but in recent years progress has been made in treatments that are suitable for older patients. It is also important that we can identify which older patients really benefit from a treatment,’ explains Issa. ‘That should become clear in clinical studies.’
More information
Lees Issa’s proefschrift: Treatment and survival of patients with Non-Hodgkin Lymphoma: population based studies in the Netherlands