Management of mantle cell lymphoma in the elderly

The average age of patients diagnosed with mantle cell lymphoma appears to be increasing. Although the majority of patients are now diagnosed in their seventh or eighth decade of life, the populations reported in clinical trials tend to be considerably younger. Recently, cooperative groups around the world have begun to focus on older patients, with clinical trials yielding important and sometimes surprising results. Novel (and some not-so-novel) therapies are increasingly being evaluated as a means to improve quality of life, not just progression-free survival. Simultaneously, a growing interest in geriatric oncology has resulted in improvements in our ability to identify individuals at risk for treatment-related morbidity and mortality. Treatment recommendations for the older patient must take into account all of these developments and should take care not to oversimplify or dichotomize patients based on chronological age alone. Just as there are some older patients that may benefit from more aggressive therapies, there are likely some younger patients that would benefit from less intensive regimens. As always, a better understanding of lymphoma biology will lead the way to better treatments, and enrollment in clinical trials is recommended.