Clinical characteristics of non-Hodgkin's lymphoma (NHL) in Vietnam era (V) and non-Vietnam era veterans (Non V).

Abstract

8077 Background: There has been increased interest in V veterans with lymphoid malignancies. We compared the survival and severity of non-Hodgkin's lymphoma in veterans from V and non-V at a VA medical center. Methods: In an IRB- approved protocol, we reviewed the records of veterans diagnosed with NHL from January 1997 to December 2009 at the VANJHCS. Records were reviewed for demographic, clinical, pathological data, Vietnam status, number of chemotherapy treatments, radiation therapy, and total number of treatments and survival. We tabulated the Performance Status (PS), International Prognosis Index (IPI), Follicular Lymphoma International Prognostic Index (FLIPI), Charlson Comorbidity Index (CMI), the Kaplan-Feinstein Comorbidity Index (KFI), the Cumulative Illness Rating Scale (CIRS) and Vietnam status. We then performed Cox regression analyses to determine predictors of survival. Results: There were 114 veterans who met the eligibility criteria and their data was analyzed. There were 61 V and 52 non-V and 1 who did not have a documented status. The groups did not differ in the following characteristics PS, stage, laboratory parameters, IPI, FLIPI. Differences in their clinical features are summarized (Table). Survival predictors for both the V and non-V veterans were the PS, hemoglobin, LDH, albumin, grade. However, in V veterans, beta 2 microglobulin (p< 0.001), IPI (p< 0.04), FLIPI (p< 0.034) and IPIFLIPI (p< 0.005) were additional predictors of survival. Median survival for V veterans was 1,068 days (95% CI 802-?) and Non-V was 1,546 days (95% CI 464-1995) (p<0.0001). Conclusions: The V veterans were significantly younger compared to the Non-V veterans. While their stage and grade of the disease was not different, their survival was significantly shorter. V veterans with NHL may represent a distinct group of lymphoma patients with poor prognosis. Parameters V Non-V p value Age (years) Median 56 (27-67) 73 (37-89) p < 0.001 Race (AA) 17 (33%) 6 (14%) p < 0.029 Charlson comorbidity index 5 (1-12) 7 (2-12) p < 0.009 CIRS15 3 (0-5) 3.5 (1-5) p < 0.029 Number of systemic therapy 1 (0-5) 1 (0-3) p < 0.007 Survival (days) 1,068(95% CI 802-?) 1,546(95% CI 464-1,995) p < 0.0001 No significant financial relationships to disclose.