Skip to main content

Advertisement

SpringerLink
Log in

Early death in patients diagnosed with non-Hodgkin’s lymphoma

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

This study sought to identify risk factors for early death in non-Hodgkin’s lymphoma (NHL). The databases of a tertiary medical center were reviewed for adult patients diagnosed with NHL since 1985 who died within 4 months of diagnosis. Comprehensive background, disease-related data, and treatment-related data were collected and analyzed by descriptive statistics. Ninety-two patients (7 % of the patient registry) met the inclusion criteria: 40 men and 52 women of mean age 74 years. Most (86 %) had B cell NHL; the most frequent pathologic classification was diffuse large B cell lymphoma (75 %). Rates of other disease-related factors were as follows: aggressive disease, 90 %; stage IV, 73 %; bulky disease, 66 %; extranodal involvement, 86 % (usually >1 site); performance score 2–4, 76 %; international prognostic index 3–5, 89 %; and B symptoms, 84 %. Mean Ki-67 proliferation index was 71 %. Additionally, 80 % of patients had a high lactose dehydrogenase level, 89 % a high beta-2 microglobulin level, and 47 % serosal (mainly pleural) effusion. A history of other cancer or organ transplantation was documented in 24 %. Chemotherapy was administered to 59 %, mostly CHOP. In conclusion, early death occurs in at least 7 % of patients with newly diagnosed NHL. This patient group is characterized by older age, aggressive lymphoma, poor performance status, advanced-stage disease, extranodal disease, B symptoms, bulky disease, elevated lactate dehydrogenase and beta-2 microglobulin levels, and serosal effusion. These early death resulted from sepsis, severe underlying disease, disease progression, or gastrointestinal perforation. The selection of appropriate treatment modalities for these patients with poor prognostic features is a real challenge. They should undergo comprehensive geriatric assessment and receive individualized tailored treatments with protocol adjustment to their condition, strict clinical surveillance, best supportive care, and maybe, as recently suggested, a prephase treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Reeder CB, Ansell SM (2011) Novel therapeutic agents for B-cell lymphoma: developing rational combinations. Blood 117:1453–1462

    Article  PubMed  CAS  Google Scholar 

  2. Lenz G, Staudt LM (2010) Aggressive lymphomas. N Engl J Med 362:1417–1429

    Article  PubMed  CAS  Google Scholar 

  3. Luminari S, Cesaretti M, Rashid I, Mammi C, Montanini A, Barbolini E, Bellei M, Pennese E, Sirotti MA, Marcheselli L, Partesotti G, Bari A, Maiorana A, Bonacorsi G, Federico M (2007) Incidence, clinical characteristics and survival of malignant lymphomas: a population-based study from a cancer registry in northern Italy. Hematol Oncol 2:189–197

    Article  Google Scholar 

  4. Pulte D, Gondos A, Brenner H (2008) Ongoing improvement in outcomes for patients diagnosed as having non-Hodgkin lymphoma from the 1990s to the early 21st century. Arch Intern Med 168:469–476

    Article  PubMed  Google Scholar 

  5. Gomez H, Hidalgo M, Casanova L, Colomer R, Pen DL, Otero J, Rodríguez W, Carracedo C, Cortés-Funes H, Vallejos C (1998) Risk factors for treatment-related death in elderly patients with aggressive non-Hodgkin’s lymphoma: results of a multivariate analysis. J Clin Oncol 16:2065–2069

    PubMed  CAS  Google Scholar 

  6. The International Non-Hodgkin’s Lymphoma Prognostic Factor Project (1993) A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med 329:987–994

    Article  Google Scholar 

  7. Swerdlow SH, Campo E, Harris NL et al (2008) WHO Classification of tumours of haematopoietic and lymphoid tissues. International Agency of Research on Cancer Scientific, Lyon

    Google Scholar 

  8. Dumontet C, Mounier N, Munck JN, Bosly A, Morschauser F, Simon D, Marit G, Casasnovas O, Reman O, Molina T, Reyes F, Coiffier B (2002) Factors predictive of early death in patients receiving high-dose CHOP (ACVB regimen) for aggressive non-Hodgkin's lymphoma. a GELA study. British J Haematol 118:210–217

    Google Scholar 

  9. Ray-Coquard I, Ghesquiere H, Bachelot T, Borg C, Biron P, Sebban C, LeCesne A, Chauvin F, Blay JY, ELYPSE Study Group (2001) Identification of patients at risk for early death after chemotherapy in solid tumours and lymphomas. Br J Cancer 85:816–822

    Article  PubMed  CAS  Google Scholar 

  10. Cox MC, Nofroni I, Ruco L, Amodeo R, Ferrari A, La Verde G, Cardelli P, Montefusco E, Conte E, Monarca B, Aloe-Spiriti MA (2008) Low absolute lymphocyte count is a poor prognostic factor in diffuse large B-cell lymphoma. Leuk Lymphoma 49:745–751

    Article  Google Scholar 

  11. O’Brien ME, Borthwick A, Rigg A, Leary A, Assersohn L, Last K, Tan S, Milan S, Tait D, Smith IE (2006) Mortality within 30 days of chemotherapy: a clinical governance benchmarking issue for oncology patients. Br J Cancer 95:1632–1636

    Article  PubMed  Google Scholar 

  12. Dass DK (2006) Serous effusions in malignant lymphomas: a review. Diagn Cytopathol 34:335–347

    Article  Google Scholar 

  13. Ellis A, Blickstein D, Manor Y, Radnay J, Shapiro H, Lishner M (1998) Pleural effusion in patients with non-Hodgkin's lymphoma. Cancer 83:1607–1611

    Article  Google Scholar 

  14. Smith TJ, Khatcheressian J, Lyman GH (2006) Update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 24:3187–3205

    Google Scholar 

  15. Bohlius J, Herbst C, Reiser M, Schwarzer G, Engert A (2008) Granulopoiesis-stimulating factors to prevent adverse effects in the treatment of malignant lymphoma. Cochrane Database Syst Rev (4):CD003189

  16. Bohlius J, Reiser M, Schwarzer G, Engert A (2003) Impact of granulocyte colony-stimulating factor (CSF) and granulocyte-macrophage CSF in patients with malignant lymphoma: a systematic review. Br J Haematol 122:413–423

    Article  PubMed  CAS  Google Scholar 

  17. Rao AV, Seo PH, Cohen HJ (2004) Geriatric assessment and comorbidity. Sem Oncol 31:149–159

    Article  Google Scholar 

  18. Hurria A, Lashs MS, Cohen HJ, Muss HB, Kornblith AB (2006) Geriatric assessment for oncologists: rationale and future directions. Crit Rev Oncol Hematol 59:211–217

    Article  PubMed  Google Scholar 

  19. Siegel AB, Lachs M, Coleman M, Leonard JP (2006) Lymphoma in elderly patients: novel functional assessment techniques provide better discrimination among patients than traditional performance status measures. Clin Lymphoma Myeloma 7:65–69

    Article  PubMed  Google Scholar 

  20. Pfreundschuh M (2010) How I treat elderly patients with diffuse large B-cell lymphoma. Blood 116:5103–5110

    Article  PubMed  CAS  Google Scholar 

  21. Pfreundschuh M, Trümper L, Kloess M, Schmits R, Feller AC, Rübe C, Rudolph C, Reiser M, Hossfeld DK, Eimermacher H, Hasenclever D, Schmitz N, Loeffler M, German High-Grade Non-Hodgkin's Lymphoma Study Group (2004) Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood 104:634–641

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Gloria Ginzach for the helpful and wonderful language editing.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Institute of Hematology, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Osnat Bairey, Michal Bar-Natan & Ofer Shpilberg

  2. Institute of Hematology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, 49100, Israel

    Osnat Bairey

Authors
  1. Osnat Bairey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michal Bar-Natan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ofer Shpilberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Osnat Bairey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bairey, O., Bar-Natan, M. & Shpilberg, O. Early death in patients diagnosed with non-Hodgkin’s lymphoma. Ann Hematol 92, 345–350 (2013). https://doi.org/10.1007/s00277-012-1623-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-012-1623-y

Keywords

Search

Navigation