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Primary CNS Lymphoma in the Elderly: The Challenge
Tali Siegal1, Osnat Bairey2,3
1Neuro-Oncology Center, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel, talisi1@clalit.org.il.
Acta Haematologica
|February 21, 2019
Summary
Primary central nervous system lymphoma disproportionately affects the elderly, with survival rates unchanged for decades. Treatment requires individualized approaches considering patient fitness and comorbidities to balance efficacy and toxicity.
Area of Science:
- Neuro-oncology
- Geriatric Medicine
- Hematology
Background:
- Primary central nervous system (CNS) lymphoma is an aggressive brain tumor with increasing incidence in the elderly population.
- Current median survival for patients over 70 years remains poor at 6-7 months, with no improvement over 40 years.
- Chronological age is an inadequate predictor of treatment tolerability and toxicity in elderly patients.
Purpose of the Study:
- To review the challenges and considerations in treating elderly patients with primary CNS lymphoma.
- To emphasize the need for individualized treatment strategies based on comprehensive geriatric and comorbidity assessments.
- To highlight the unresolved optimal treatment approach and the potential role of new therapeutic agents.
Main Methods:
- Review of existing literature on primary CNS lymphoma in the elderly.
- Analysis of treatment tolerability, toxicity, and survival outcomes.
- Discussion of the limitations of chronological age as a sole determinant for treatment decisions.
Main Results:
- Elderly patients exhibit variable tolerance to chemotherapy and radiotherapy, ranging from high-dose regimens to intermediate methotrexate doses.
- Whole-brain irradiation poses risks of accelerated cognitive side effects in the elderly.
- Individualized treatment plans are crucial to manage treatment-induced CNS and systemic toxicity.
Conclusions:
- Optimal treatment for elderly patients with primary CNS lymphoma requires a comprehensive geriatric assessment to tailor therapy.
- An individualized approach is necessary to prolong survival while minimizing treatment-related toxicity.
- Future research should explore novel agents to improve outcomes and maintain quality of life in this population.
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