The importance of age in survival of patients treated with chemotherapy for aggressive non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma (NHL) is a malignancy that occurs frequently in the elderly with a median age >60 years. However, most chemotherapy trials have included predominantly patients < 60 years of age. We treated 157 patients with diffuse aggressive NHL between September 1982 and May 1986 with cyclophosphamide, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), procarbazine, bleomycin, vincristine, and prednisone (CAP/BOP). There were no treatment exclusions for age. Patients in this study ranged in age from 15 to 91 years (median, 63) with 112 patients ≥ 60 years of age. The overall complete remission (CR) rate was 65% with no significant difference for age < 60 (76%) v age ≥ 60 (61%) (P = .18). With a median 36-month follow-up (range, 22 to 65 months), the overall 5-year survival was 42%. The patients < 60 years old had a 62% 5-year survival in contrast to a 34% 5-year survival in those patients ≥ age 60 (P = .01). The deaths attributed to tumor or treatment-related toxicity were similar above and below age 60. The difference in survival was due to other causes of death not obviously related to the lymphoma or its therapy - occurring in 22% of patients ≥ 60 years of age but only 2% of patients < 60 years (P = .005). Our data supports the position that aggressive NHL in elderly patients is not significantly less responsive than in younger patients; however, the inclusion of older patients in clinical trials will decrease the overall survival secondary to deaths due to apparently unrelated causes.