Analysis Of Clinical Features And Treatment Status Of Elderly Lymphoma

Objective:Through a retrospective study of the cases,the overall distribution of lymphoma admitted and treated in the hematology department of Da Lian central hospital in recent 8 years was summarized.To investigate the general situation,clinical characteristics,laboratory indexes,pathological characteristics and treatment programs of elderly lymphoma,and to provide help for clinicians in the diagnosis,stratified and individualized treatment and prognosis evaluation of elderly lymphoma.Methods:From January 1.2010 to December 31,2017,203 lymphoma patients admitted and treated by the department of hematology,central hospital of Da Lian city who were confirmed by pathology after surgery or biopsy were collected as subjects.Analysis the lymphoma patients in the general situation(age,gender),clinical characteristics(primary location,extranodal involvement,symptoms of group B,IPI,clinical stage,KPS,BMI,complications,etc.),Laboratory examination(hemoglobin,LDH,ALC,CRP,ESR,β2-microglobulin,etc.),Pathological characteristics(pathological type,ki-67),Treatment regimen(R-CHOP regimen.CHOP regimen,etc.).The elderly group was aged 60 years old,and the non-elderly group was aged<60 years old.SPSS24.0 statistical software was used for analysis,and the test level α=0.05,To analyze the differences in general situation,clinical characteristics,pathological characteristics and treatment plan between the elderly group and the non-elderly group.Results:Among the 203 patients with lymphoma,110 were males and 93 were females.slightly more males than females(male:female=1.18:1),with a median age of 60.7 years.Among the 202 cases with known pathological types,166 cases(82%)were from B-cell lineage and 36 cases(18%)were from T-cell lineage.Among them,88 cases(44%)were diffuse large B cell lymphoma.1.In the elderly group,116 patients(57%)had a sex ratio(male:female=1.19:1),with a median age of 71.0 years.There were 87 cases(43%)in the non-elderly group,with gender ratio(male:female=1.17:1)and median age of 47.1 years old.In the elderly group,64 patients(55%)had primary lymphadenopathy,and 53 patients(46%)had superficial lymphadenopathy.52 cases(45%)were originated from the external organs,13 cases(11%)from the pharynx,and 10 cases(9%)from the gastrointestinal tract.There were 103 cases of extranodal involvement(89%).Among the non-elderly group,60 patients(69%)had primary lymphadenopathy,and 52 patients(60%)had superficial lymphadenopathy.27 cases(31%)were originated from the external organs,and 7 cases(8%)were mainly from the gastrointestinal tract.There were 59 cases(71%)of extranodal involvement.2.In the IPI scores of the elderly and non-elderly patients,the low-risk group(7%vs23%),the low-risk group(13%vs45%),the medium-high risk group(37%vs29%),and the high-risk group(43%vs3%);Ⅰ-Ⅱ vs21%(10.3%),Ⅲ-Ⅳ vs79%(89.7%);KPS>score 70(83%vs 96.6%),KPS score<70(17%vs3.4%).3.There were group B symptoms(43%vs44%),bone marrow infiltration(25%vs12%),and complications(66%vs40%)in the elderly and non-elderly groups.4.In the elderly and non-elderly groups,anemia(29%vs27%),decreased lymphocyte count(30%vs19%),increased ESR(39%vs48%),increased C-reactive protein(17%vsl9%),lactate dehydrogenase(38%vs41%),and β2-microglobulin(59%vs29%)were observed.5.In the elderly group,112 patients(97.3%)had non-hodgkin’s lymphoma,of whom 85(74%)had invasive histological subtypes.The main pathological types:diffuse large B-cell lymphoma in 53 cases(45.7%),small lymphocytic lymphoma in 12 cases(10.4%),mucosa associated b-cell lymphoma in 9 cases(7.8%),Angi-immmunoblastic T cell lymphoma in 8 cases(7.0%),peripheral T-cell lymphoma in 6 cases(5.2%),etc.In the non-elderly group.72 patients(83%)had non-hodgkin’s lymphoma,of whom 62(71%)had invasive histological subtypes.The main pathological types:diffuse large B-cell lymphoma in 35 cases(40.2%),peripheral T-cell lymphoma in 7 cases(8.0%),mucosa associated b-cell lymphoma in 5 cases(5.7%),Angi-immmunoblastic T cell lymphoma in 5 cases(5.7%),etc.The elderly group had 50 patients(55%)with ki-6750%.There were 41 patients(60%)with ki-67 50%in the non-elderly group.6.R-CHOP scheme(21%vs21%),CHOP scheme(40%vs34%),CHOPE scheme(0%vs6%),COP scheme(8%vs s3%)were applied in the aged and non-aged groups.Conclusion:1.Lymphoma is more common in male than female,especially in middle and old age.The most common histological subtype is diffuse large B cell lymphoma.2.This research shows that about 43%of older lymphoma patients with B symptoms,66%of patients had complications,IPI score more than 3 points,or clinical stage Ⅲ-Ⅳ.It suggests that the clinical symptoms of elderly lymphoma are more atypical,easy to be ignored,and found late,rapid progress.3.The treatment of lymphoma patients in primary hospitals is affected by age,family members’ ideas,general state,economy and other factors.Only about 20%of patients can receive standardized treatment according to the guidelines.4.It is necessary to strengthen the publicity of lymphoma,especially the elderly lymphoma disease,improve the cognition of lymphoma in the society,conduct regular physical examination,actively treat lymphoma,reduce misdiagnosis and missed diagnosis,and improve the quality of life and survival of lymphoma patients.