Lymphoma in elderly patients needs special attention because elderly patients represent half of all cases (the median age for all lymphomas is around 60–65 years) and because elderly patients usually require a different management compared to younger patients. Indeed, such patients usually have one or more other diseases diagnosed before the lymphoma; diseases that may alter their capacity to tolerate lymphoma treatment . Moreover, the incidence of lymphoma in elderly patients has recently increased, probably more than that of young patients, and although recent results showed a trend to stabilisation, this will not occur for the elderly simply because they are living longer and the number of elderly patients will therefore increase [2, 3]. Few differences have been described in morphology and clinical presentation between young and elderly patients with lymphoma . However, the prognosis for elderly patients with lymphoma is worse, particularly for those with aggressive subtypes, because of the difficulties encountered during treatment: difficulties related to the presence of other diseases, diminished organ function, and altered drug metabolism [1, 5, 6]. Recent studies have concluded that the best way to improve the survival of elderly patients with lymphoma was to treat them correctly, that is, with an optimal chemotherapy regimen [3, 7–9].
Treatment of lymphoma patients has completely changed during the last 5 years with the use of monoclonal antibodies, particularly rituximab [10, 11]. Rituximab, an unconjugated anti-CD20 chimeric monoclonal antibody, was the first monoclonal antibody to be used and the only one that has demonstrated activity in randomised studies . Rituximab may be used alone, particularly in patients with follicular lymphoma, [13, 14] but its major activity has been demonstrated in combination with chemotherapy [11, 15, 16]. Rituximab does not add any toxicity to standard chemotherapy regimens and may thus be used safely in elderly patients without compromising their quality of life.
AGE AS A PROGNOSTIC FACTOR
Several studies have reported that older age correlated with shorter disease-free and overall survivals. In a study of 307 patients treated with CHOP (cyclophosphamide, adriamycin, vincristine, prednisone), the disease-free survival rates fell from 65% at 96 months for subjects less than 40 years old to 50% at 36 months for those older than 65 years . A Scottish study demonstrated that stage and histology are comparable in patients under and over age 60, though the elderly have a significantly poorer survival . Advancing age has also been associated with increased treatment-related death rates.
Elderly patients usually have a more severe level of disease than young and middle-aged patients: complete remission rates decline steadily with age, from 68% in the young to 45% in the elderly . Median event-free and overall survivals also decline with age (Table ...