Treatment of elderly patients with aggressive non-Hodgkin's lymphoma

Half of the patients with aggressive non-Hodgkin's lymphoma are elderly. Standard treatment regimens have been disappointing, though many patients die of nonmalignant concomitant disease. Specifically designed treatment combinations do not seem to have a positive impact on survival in these patients. With growth factors the infection rate declines, but no survival benefit occurs. Dose reductions could reduce treatment-associated complications, but lymphoma recurrences increase and complete remissions decline. The treatment has to be adjusted to organ dysfunctions. Elderly patients without concomitant disease and with a good performance status may have a similar therapeutic outcome as younger patients, if they are treated with intensive chemotherapy. In patients with a poor performance status treatment is palliative.