Evolution and prognosis of adult patients with non-Hodgkin lymphoma

Abstract

19527 Background: Non-Hodgkin Lymphoma (NHL) is a malignant neoplasm of lymphoid system with marked differences in presentation and prognosis. The objective was to determine the clinical behavior and prognostic factors of the patients with NHL. Methods: 2834 clinical records of patients with LNH diagnosed at INEN between 1990 and 1999 were reviewed. We described the clinical-pathological characteristics, treatment and response. The complete response (CR) and recurrence rate were compared by Chi-square or exact Fisher test. The survival curves were estimated by Kaplan-Meier and comparisons by Logrank or Breslow test. The prognostic factors for CR were identified by logistic regression and for survival by Cox model. Results: The median age was 55 years (range: 14–96), most of them between 45 and 74 years, and 50% were male. The clinical characteristics were: zubrod ≥2 (28%), primary node disease (64%), B-symptoms (36%), clinical stage III-IV (52%), anemia (51%), leukocytosis (20%), increased DHL and β2M in 48% and 36% respectively. 90% had aggressive lymphoma and 53% intermediate-high and high risk IPI. 2221 (78%) patient received treatment: chemotherapy alone (CT) 67%, radiotherapy alone (RT) 8% and CT+RT 20%; CHOP was the most frequent CT scheme (84%). 64% had CR and 21% PR; 191/723 (26%) had recurrence. The median follow-up was 15 months. The 5-year DFS (disease-free-survival) and OS (overall survival) were 58% and 48%. The prognostic factors for CR were age > 60 (p=0.027, RR: 0.71), male sex (p=0.001, RR: 1.6), zubrod ≥2 (p<0.001, RR: 1.8), stage III-IV (p<0.001, RR: 2.0) and increased DHL (p<0.001, RR: 1.9). CS III-IV (p<0.001, RR: 2.0) and increased DHL (p<0.001, RR: 1.7) for DFS. Zubrod ≥ 2 (p<0.001, RR: 2.2), B symptoms (p=0.030, RR: 1.3), CS III-IV (p<0.001, RR: 2.0), leukocytosis (p<0.001, RR: 1.7) and increased DHL (p<0.001, RR: 1.8) for OS. Conclusions: The presentation of NHL was similar to other series, although with higher frequency of anemia, advanced disease, aggressive lymphoma that conditioned the prognosis. CR, DFS and OS, were similar to other series. Clinical stage and increased DHL are prognostic factors to take into consideration in the follow-up, since they are related to the tumor volume. In our serie, leukocytosis was also an important prognostic factor for OS. No significant financial relationships to disclose.