Non-Hodgkin’s (NHL) Lymphoma Patients(pts) in the VA Population: Clinical Characteristics and Survival Predictors.
Authors: Cholankeril Michelle , Hoover Donald , Srinivas Shanti , Chang Victor T. , Sikder Manzurul , Gonzalez Melanie , Kasimis Basil 
Published: October 2019

Background: To describe the clinical characteristics (CC) and survival predictors in NHL pts at a VA medical center.

Methods: We performed a retrospective chart review of all pts diagnosed with Non Hodgkin’s lymphoma at the VANJHCS from January 1, 1997 through December 31, 2006. Records were reviewed for demographic, clinical, pathological data and survival. Statistical analyses were performed using STATA. The study was approved by the IRB.

Results: 1. Clinical characteristics. There were 92 pts, with 57 deaths(62%). The median (M) age was 62 years (range 27–89). The race distribution was Caucasian 66(72.5%), African American 19(21%), other (6, 6.5%). The overall M survival (MS) was 698 days(13–3825). The M Hemoglobin(Hgb) was 12.3 g/dl (7.3–17.4) The M LDH was 203 IU/L(88–1905). The M Albumin was 3.6 g/dl (1.2–5.4). Beta 2 microglobulin (B2M) and HIV status were not available on all patients. The M Zubrod Performance Status (PS) was 1(0–4). The PS for 46 pts (50%) was 1(0–4). By Ann Arbor Stage, 44 pts(49%) were in stage I–II, and 46 pts(51%) had stages III–IV. MS for pts in stage I–II were 887.5(range 13–3713) days and 552(range 22–3825) days in stages III–IV. 2. Survival by histology is summarized in the accompanying table. Histological categories were low grade (CLL, follicular, MALT, marginal zone), diffuse large cell lymphoma, mantle cell lymphoma (MCL) and other(2 pts). The most common class of pts was low grade 49(53%), followed by intermediate 34(36.9%) and mantle cell lymphoma 9(9.7%). 3. Clinical Prognostic indicators: Charlson Comorbidity Index (CMI), the International Prognostic Index (IPI) and the Follicular Lymphoma International Prognostic Index (FLIPI) scores were tabulated. For pts with intermediate lymphoma, the M IPI score was 3 (range 0–5), and for low grade lymphoma M IPI score 2 (0–5). The 47 pts with low grade lymphomas had median FLIPI score of 1 (0–4). The M CMI was 6(1–12). 4. For all pts, univariate predictors of survival were lymphoma class, hemoglobin, PS, LDH, albumin. The IPI was a significant predictor on univariate analysis. In multivariate analysis, the PS(p<0.02), Albumin (p<0.02), CMI (p<0.05), LDH (p<0.06) and lymphoma class (p<0.02) were significant predictors. For low grade lymphoma pts, univariate predictors were LDH, albumin, IPI, and PS, but not the FLIPI. On multivariate analysis, the predictors were PS (p<0.02), and albumin (p<0.018). For intermediate grade lymphoma pts, univariate predictors were albumin, but not the IPI. On multivariate analysis, the PS (p<.006), albumin (p<0.03), and CMI (p<.02) were significant predictors.

Conclusions: In this sample, prognostic factors differed for low grade and intermediate grade lymphomas. IPI did not predict survival in intermediate lymphoma pts. Comorbidity emerged as a potential prognostic factor for pts with intermediate grade lymphomas. The VA provides care for a large veteran population characterized by low socioeconomic status and higher comorbidity. These findings should be confirmed in larger VA and general populations.

Survival by Histology Lymphoma type Number of pts Median survival(days) Range(days) Diffuse large 32(37%) 466 17–3402 CLL 14(15%) 1711 25–3541 Follicular 19(20%) 943 13–3825 Mantle cell 9(10%) 748 62–1231 Marginal zone 8(9%) 627 197–2686 MALT 8(9%) 1311 393–3194