Seniors with Non-Hodgkin Lymphoma More Likely to Die
if Poor, to Survive with Chemo
NHL increasing; Caucasians have higher incidence and
death rates than other ethnic groups.
Oct. 20, 2008 A large study of senior citizens
has found that older patients with non-Hodgkin lymphoma (NHL), a type of
cancer common in the elderly, are more likely to die if they are of a
poorer socioeconomic status and more likely to survive if treated with
chemotherapy. NHL is expected to be the fifth most common cancer in
American men and women in 2008, and a top-10 cause of death for both,
according to American Cancer Society estimates.
The new finding are reported in the
December 1, 2008 issue of CANCER, a peer-reviewed journal of the
ACS. (Below this news story are brief reports on several other recent
developments related to this cancer.)
There are about 65,000 new cases of NHL diagnosed
in the U.S. every year. The number of cases is increasing, especially
among older people and people whose immune systems are not functioning
normally. Those at high risk include people who have had organ
transplants and those with human immunodeficiency virus (HIV).
Caucasians have higher incidence and death rates
related to the disease than patients in other ethnic groups. Newer
treatments for NHL have become available in recent years, but these
researchers determined there was a need for more studies of the ethnic
disparities in survival, as they relate to treatment, diagnosis,
socioeconomic status, or other factors.
To investigate the issue, Dr. Xianglin Du of the
University of Texas School of Public Health in Houston and colleagues
analyzed SEER (Surveillance, Epidemiology and End Results)-Medicare
linked data for more than 13,000 patients diagnosed at age 65 or older
between 1992 and 1999.
Dr. Du and his team analyzed data related to
survival, socioeconomic status, treatment (chemotherapy or radiation),
tumor factors (stage and type of NHL), the presence of other diseases or
conditions, and other characteristics such as age, race, marital status,
and geographic area.
The investigators found that receiving chemotherapy
was associated with prolonged survival in patients with NHL and that
elderly Caucasian patients with NHL were more likely to receive
chemotherapy (52.4 percent) compared with African-Americans (43.2
percent).
Also, poor socioeconomic status was significantly
associated with increased risk of mortality, and there were a larger
proportion of African-American patients living in poor communities
compared with other ethnicities.
No significant differences in the risk of death
were seen between African-Americans and Caucasians after controlling for
factors such as treatment and socioeconomic status.
About Lymphoma
Also called: Non-Hodgkin's lymphoma
Lymphoma is a cancer of a part of the immune system
called the lymphatic system. There are many types of lymphoma. One type
is called
Hodgkin's disease. The rest are called non-Hodgkin's lymphoma.
Non-Hodgkin's lymphomas begin when a type of white
blood cell, called a T cell or B cell, becomes abnormal. The cell
divides again and again, making more and more abnormal cells. These
abnormal cells can spread to almost any other part of the body. Most of
the time, doctors can't determine why a person gets non-Hodgkin's
lymphoma.
Non-Hodgkin's lymphoma can cause many symptoms,
such as
● Swollen, painless lymph nodes in the neck,
armpits or groin
● Unexplained weight loss
● Fever
● Soaking night sweats
● Coughing, trouble breathing or chest pain
● Weakness and tiredness that don't go away
● Pain, swelling or a feeling of fullness in the abdomen
Non-Hodgkin's lymphomas are a diverse group of
cancers that develop in B or T lymphocytes, which are white blood cells
that normally defend the body against bacteria and other pathogens. This
group of cancers is actually the cause of more than 20 diseases, which
have distinct appearances under the microscope and different clinical
courses. Most non-Hodgkin's lymphomas are from B cells.
Editors Notes:
The metropolitan areas of San Francisco/Oakland,
Detroit, Atlanta, Seattle, Los Angeles County, San Jose/Monterey, and
the states of Connecticut, Iowa, New Mexico, Utah, and Hawaii were
included in this study.
Article: "Ethnic variations in diagnosis,
treatment, socioeconomic status and survival in a large population-based
cohort of elderly patients with Non-Hodgkin's Lymphoma." Michael Wang,
Keith D. Burau, Shenying Fang, Harry Wang, and Xianglin L. Du. CANCER;
Published Online: October 20, 2008 (DOI: 10.1102/cncr.23914); Print
Issue Date: December 1, 2008.
More Recent
News About Non-Hodgkin Lymphoma
New Non-Hodgkin Lymphoma Drug Shows Promise
Aug. 14, 2008 (HealthDay News) - Preliminary
results from an early trial of a new immunotherapy suggests doctors may
soon have another weapon for the treatment of non-Hodgkin lymphoma.
A team of German scientists and clinicians led by
Patrick Baeuerle, chief scientific officer at Micromet AG, a
Munich-based biopharmaceutical company, demonstrated partial or complete
tumor regression in 11 of 38 human patients given low doses of
blinatumomab, a protein that tethers tumor-killing T-cells to cancerous
B cells.
Each of these 38 patients had already tried a
median of three standard therapies for non-Hodgkin lymphoma, and their
prospects were grim, Baeuerle said.
"They could have died within months to a year or
two," he said. "They were all terminally ill patients."
Four patients, all of whom received at least 30
micrograms per square-meter per day for between four and eight weeks,
have been in remission at least six months; the longest has been
cancer-free over 13 months.
The research was published in the Aug. 15 issue of
Science.
Drugs Successful with Myeloma May Help Fight Other
Blood Cancers
In September the International Myeloma Foundation
declared that survival rates have improved dramatically for patients
with multiple myeloma, a cancer of the bone marrow that affects blood
cell production. In the last 25 years, survival rates over two years
have improved from less that 66% to about 90%.
"What has changed is not the research capability,
it is the availability of potent new classes of drugs without the side
effects typically associated with chemotherapy," said IMF chairman Brian
G.M. Durie.
He pointed to drugs such as Revlimid and Velcade,
with improved outcomes.
He said their success with myeloma is now
benefiting a wide range of blood cancers as these drugs are being tested
in non-Hodgkin's lymphoma, chronic lymphocytic leukemia and other blood
cancers.
October 10, 2008 edition of the Journal of Clinical
Oncology
News from Cancer: Risk factors for deadly form of
lymphoma
A study released in August indicates that the
incidence of mantle cell lymphoma, an aggressive type of non-Hodgkin's
lymphoma, is on the rise, most frequently striking men, Caucasians and
the elderly. It also reveals that most patients are diagnosed with
advanced stages of the disease.
Mantle cell lymphoma was first established as a
type of lymphoma in 1992. It is a fast-growing cancer of the immune
system that is characterized by small- to medium-size cancer cells that
may be in the lymph nodes, spleen, bone marrow, blood or
gastrointestinal system. Despite the availability of many different
types of therapies, the cancer remains incurable.
Dr. Michael Wang of the University of Texas M.D.
Anderson Cancer Center and colleagues examined cancer registry data from
1992 to 2004, the most recent year for which complete data are
available. It included the records of 2,459 patients (2.8 percent of all
patients with non-Hodgkin's lymphoma) diagnosed with mantle cell
lymphoma during the time period.
They found:
● Men were more than twice as likely to be diagnosed with the disease
as women,
● Caucasians had the highest risk of all ethnic groups,
● Advanced age was a significant risk factor,
● People between the ages of 70 to 79 more likely to be diagnosed with
mantle cell lymphoma than all other age groups.
● Almost three-quarters of all mantle cell patients were diagnosed
with advanced disease (stage III and IV).
Trends:
● incidence rates increased progressively over
time.
● In 1992, only 2.7 people per 1,000,000 were diagnosed, compared
with 6.9 people per 1,000,000 in 2004.
● The cause of this remarkable increase in the incidence rate of the
disease over the past 13 years is unknown.
It has the poorest prognosis of all lymphomas.
Despite the recent discovery of new anti-cancer therapies that have
improved the survival rates of patients with various types of
non-Hodgkin's lymphoma, there is no clear standard approach for treating
mantle cell lymphoma.
The study was published in the August 15, 2008
issue of CANCER, a peer-reviewed journal of the American Cancer Society
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