The Treatment of Elderly Patients with Aggressive Non-Hodgkin’s Lymphoma

The treatment of elderly patients with an aggressive non-Hodgkin’s lymphoma has gradually changed over the last decades. The first publications concerning elderly patients with lymphoma emphasized the increased toxicity and poor outcome of this patient group.(1-3) The aim of many subsequent studies has been to decrease toxicity.(4-6) Most of these studies however reported decreased response rates and deterioration of survival if age adapted therapy was used. It also became evident that doxorubicin proved to be a toxic, but essential drug in any regimen prescribed with a curative intention.(7-9) The development of recombinant granulocyte colony-stimulating factor (G-CSF) raised expectations that this growth factor could improve the results of therapy because it would become possible to maintain the dose-intensity of the chemotherapy regimen by inducing rapid hematopoietic recovery.(10) Moreover, a shorter duration of the neutropenic phase could probably reduce the incidence of neutropenic fever, bacterial infections and the number of hospital admissions.(11, 12) In the current thesis the results of a large prospective multicenter clinical trial are reported. This trial was designed to investigate if prophylactic G-CSF administration could improve the poor results of treatment in elderly patients with an aggressive non-Hodgkin’s lymphoma. The primary question was whether a higher relative dose-intensity would lead to improved treatment outcome. Secondary endpoints were the quality of life and the cost-effectiveness associated with such treatment. This trial was supported by the Dutch government.