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

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.