Real-world outcomes of very elderly lymphoma patients in Sweden

On 21 November 2018, Tove Wästerlid from Karolinska Institute, Stockholm, SE, and colleagues, published in Blood a population analysis performed via the Swedish Lymphoma Registry (> 95% national coverage). This study focused on the outcomes and clinical characteristics of very elderly patients with major lymphoma types.

Very elderly lymphoma patients usually present with comorbidities and their frailty usually renders them ineligible for most clinical trials. Thus, treatment regimens are limited and not thoroughly researched in this population. The aim of the study here was to evaluate, specifically in individuals aged ≥ 85, lymphoma outcomes and treatment choices. The primary endpoint of the study was overall survival (OS).

Study design

• N = 1191 patients ≥ 85 years diagnosed with malignant lymphoma between 2007–2013
• Of those, n = 298 (25%) were aged ≥ 90
• Data collection from the Swedish Lymphoma Register
• Patient diagnoses:
• Grouped as aggressive lymphomas: 
  • Diffuse large B-cell lymphoma (DLBCL)
  • T-cell lymphoma
  • Hodgkin lymphoma (HL)                                         
  • Mantle cell lymphoma (MCL)
• Grouped as indolent lymphomas:
  • Follicular lymphoma (FL)
  • Marginal zone lymphoma (MZL)                            
  • Waldenström macroglobulinemia (WM)

Results

• Lymphoma subtypes occurrence rates (from most to least common):
  • DLBCL (n = 458, 38%)
  • WM (n = 125, 11%)
  • FL (n = 98, 8%)
  • T-cell lymphoma (n = 78, 7%)
  • MCL (n = 75, 6%)
  • MZL (n = 48, 4%)
  • HL (n = 36, 3%)
• Clinical characteristics across all patients:
  • Elevated lactate dehydrogenase (LDH): 36%
  • Performance status score > 2: 39%
  • Ann Arbor stage III–IV: 49%
  • Bulky disease: 11%
  • Systemic B-symptoms: 25%
• Treatment data were available from n = 887 (75%) patients:
  • Aggressive lymphoma patients:
    • Received active treatment: 72% (n = 389), of which 44% had curative intent
    • Most common treatment was dose-reduced rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)
  • Indolent lymphoma patients:
    • Received active treatment: 49% (n = 124)
    • Most common treatment was chlorambucil, bendamustine or trofosfamide
  • Two-year OS rate per lymphoma subtype:
    • DLBCL: 30.5%
    • WM: 61.4%
    • FL: 54.2%
    • T-cell lymphoma: 25.6%
    • MCL: 27.2%
    • MZL: 62.1%
    • HL: 16.7%
  • Two-year OS for aggressive versus indolent lymphoma group:
    • 5% versus 58.7%
  • Two-year OS was statistically longer with active treatment administration only in patients with:
    • DLBCL: 39% (active treatment) versus 6% (no active treatment; HR = 0.34; 95% CI, 0.23–0.51; P ≤ 0.0001
    • MZL: 81% (active treatment) versus 5% (no active treatment; HR = 0.22; 95% CI, 0.05–1.0; P = 0.05

The results of this real-world analysis in Swedish very elderly lymphoma patients, indicate that in DLBCL and MZL current active treatments offer a significantly superior survival outcome, when compared to no active treatment administration. According to the authors, this study is the largest population-based lymphoma analysis for that age group and provides valuable information on clinical disease management and how it can be improved. Updated outcome analysis from this study, and in combination with data from the Danish Lymphoma Registry will be presented at the 60^th American Society of Hematology Meeting, 2018, San Diego, CA, USA.