Diffuse Large B-Cell Lymphoma in the Elderly: Current Approaches
- PDF / 351,805 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 101 Downloads / 232 Views
GERIATRIC ONCOLOGY (L BALDUCCI, SECTION EDITOR)
Diffuse Large B-Cell Lymphoma in the Elderly: Current Approaches Pamela Allen 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Older patients with diffuse large B-cell lymphoma (DLBCL) may face challenges in treatment due to comorbidities and tolerance of chemotherapy. Recent Findings Older patients are at increased risk for treatment-related toxicity if they are unfit or frail by comprehensive geriatric assessment (CGA); however, treatment with non-anthracycline chemotherapy is associated with inferior outcomes in fit and unfit patients. Summary Many older patients remain curable with standard R-CHOP chemotherapy. Careful assessment of frailty, function, and comorbidities using CGA may aid clinicians in initial therapy choices. Keywords Diffuse large B-cell lymphoma . Elderly . Older . Frail . Anthracycline . Comprehensive geriatric assessment
Introduction Diffuse large B-cell lymphoma (DLBCL) is a common diagnosis in older adults, representing 60% of all lymphoid malignancies in this group. The definition of “elderly” varies substantially with some studies indicating age > 60 or up to age 80, while other definitions incorporate more detailed functional indices. In spite of its commonality, older patients with DLBCL face unique challenges in the treatment of DLBCL due to competing comorbidities which alter the tolerability of chemotherapy. Inferior outcomes in older patients are likely multifactorial in nature, with reduced treatment intensity, more high-risk features, and comorbidities all contributing. Forty-five to 60% of older patients with non-Hodgkin’s lymphoma (NHL) have a concurrent serious comorbidity [1, 2]. Among those with increased comorbidities, there is a decreased likelihood of completing therapy, lower achievement of complete response (CR), and diminished survival. [3] The risk of death is twice as high in those with serious comorbidities compared with those without comorbidities, independent of the International prognostic index (IPI) risk score [2]. Older age also affects the receipt and dose intensity of This article is part of the Topical Collection on Geriatric Oncology * Pamela Allen [email protected] 1
Winship Cancer institute of Emory University, 1365 Clifton Rd. NE, Suite 4000, Atlanta, GA 30030, USA
chemotherapy. In an analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicaid database, 23% of older DLBCL patients received no treatment. Among patients aged > 80 years, the rate was even higher with onethird of patients not receiving therapy. [4] As expected, comorbidities are associated with higher rates of treatment toxicity, with studies showing grade 3/4 toxicity occurring in over 50% of those with the higher comorbidity scores [2, 3]. Owing to the increased likelihood of adverse events, dose reduction and therapy interruption may be unavoidable. Unfortunately, studies show that patients receiving less or lower intensity therapy have inferior survival. In a SEER datab
Data Loading...
