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Non-Hodgkin's lymphoma in the elderly
Paolo F Caimi1, Paul M Barr, Nathan A Berger
1Department of Medicine, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA.
Drugs & Aging
|March 10, 2010
Summary
Older adults with non-Hodgkin's lymphoma (NHL) face higher toxicity risks. Comprehensive geriatric assessment (CGA) helps tailor treatments, with rituximab and targeted agents improving outcomes for indolent and aggressive NHL.
Area of Science:
- Oncology
- Geriatrics
- Hematology
Background:
- Non-Hodgkin's lymphoma (NHL) incidence is rising in older populations.
- Elderly patients face increased therapy-related toxicity due to age-related changes and comorbidities.
- Functional assessment is crucial for determining treatment tolerance and response in older NHL patients.
Purpose of the Study:
- To review treatment strategies for non-Hodgkin's lymphoma in the elderly.
- To highlight the role of comprehensive geriatric assessment (CGA) in managing older NHL patients.
- To discuss advances in therapy for indolent and aggressive NHL subtypes in older adults.
Main Methods:
- Review of current literature and clinical trial data for NHL treatment in elderly patients.
- Emphasis on the application of comprehensive geriatric assessment (CGA) for treatment stratification.
- Analysis of efficacy and safety data for novel agents and established therapies.
Main Results:
- Comprehensive geriatric assessment (CGA) aids in identifying elderly patients who will benefit from anti-neoplastic treatment.
- Rituximab, as a single agent or in combination, improves survival in first-line treatment for NHL.
- Novel agents and targeted therapies show activity against indolent lymphomas.
- Addition of rituximab to CHOP chemotherapy improves outcomes in elderly patients with diffuse large B-cell lymphoma.
- Autologous haematopoietic cell transplant (autoHCT) offers survival benefits in selected older patients, despite higher transplant-related mortality.
Conclusions:
- Treatment decisions for elderly NHL patients should incorporate functional status via CGA.
- Rituximab-based therapies and novel agents represent significant advancements in NHL management for older adults.
- Careful patient selection is essential for considering high-intensity treatments like autoHCT in elderly NHL patients.
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