Non-Hodgkin Lymphoma in Elderly Patients Above the Age of 80 in the Rituximab Era
Condition: Non-Hodgkin's Lymphoma
MeSH terms: Lymphoma; Lymphoma, Non-Hodgkin
Study type: Observational

Summary: 
      This is an exploratory analysis that is investigating the pattern of care in patients over
      the age of 80 who were diagnosed with non-Hodgkin lymphoma (NHL). This study will look at the
      dose intensity and density implemented in this patient population to calculate whether
      patients received the full course of therapy, received less duration of treatment, or
      received lower doses of the drugs administered. Furthermore, the investigators would explore
      time to disease progression for these patients regardless of the treatment received and
      investigate whether patient outcomes differ based on the type of therapy or dose
      intensity/density given.

      This study is looking at retrospectively evaluating patients with NHL who are over the age of
      80 at our institution between 2001-2007. It is anticipated that about 50 patients will be
      included in this study.
    

Detailed description: 
      Non-Hodgkin Lymphoma (NHL) is a malignant disease of the lymphoid and hematopoetic system
      with an annual incidence of 60,000 cases/year in the United States accounting for over 18,000
      deaths annually. NHL is a heterogeneous malignancy with a median age of 65 at the time of
      diagnosis. Most clinical trials that have established current standards of care did not
      include elderly patients, especially those who are above the age of 80. Reasons for such
      under representation are not well-defined but several factors are hypothesized. Patients
      above the age of 80 have many co-morbid conditions that might exclude them from enrollment on
      clinical studies that are usually designed for more fit individuals. In addition,
      investigators are often reluctant to propose trials to elderly patients as their response to
      therapy might be suboptimal compared with younger patients affecting the overall data.

      Well-designed published studies as to how patients over the age of 80 are being managed in
      the community or academic setting are lacking. There is no agreed-upon treatment algorithm
      for these patients and recommended approach varies based on the treating physician, the
      institution, and each individual patient.

      Some physicians chose to offer dose reductions while others might omit chemotherapy and use
      monoclonal antibodies alone. Furthermore, treatment duration and the number of cycles given
      might vary considerably in this patient subgroup for a variety of reasons, mainly toxicity.
      In addition, it is unclear whether the histologic distribution of NHL is similar in older
      patients. In other words, it is not clear whether patients over the age of 80 are commonly
      diagnosed with diffuse large cell lymphoma (DLCL) and follicular lymphoma (FL) similar to
      younger individuals. Most importantly, these expected variations in treatment strategies
      might have inferior outcomes when compared to younger patient population. Looking at
      histologic subtype, treatment strategies, and outcomes in patients over the age of 80 is
      useful for patients and physicians alike. It is plausible that our current standards do not
      apply to this very-older patient population arguing for offering them clinical trials or
      novel agents even as an initial approach. On the other hand, we might discover that these
      older patients fare well despite these variations arguing that their disease biology is
      different especially if we note changes in histologic distribution.
    

Observational model: Case-Only
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        This study is looking at retrospectively evaluating patients with NHL who are over the age
        of 80 at our institution between 2001-2007.
      
Keywords: Non-Hodgkin's Lymphoma