Diffuse large-cell lymphoma in the elderly: Does a clinically indolent subset exist?

Among 63 patients with intermediate or high grade non Hodgkin's lymphoma (NHL) seen at our institution in a five-year period, 19 were aged 70 years or older. For various reasons, four of these patients were either not treated or received only minimal treatment. Three of the patients remain well without evidence of disease for 1 to 3 years, and the fourth has relapsed in an indolent fashion after 3 years. These observations suggest that existence of a subset of patients with histologically aggressive non-Hodgkin's lymphoma whose disease behaves mildly. Because of the high incidence of treatment-related morbidity and mortality in elderly lymphoma patients treated with combination chemotherapy, it is important to try to identify prospectively this subset of patients clinically and to avoid overtreatment in this category of cases.