Cancer in the elderly

Byrne, Anthony; Carney, Desmond N.

doi:10.1016/0147-0272(93)90007-o

Cited by 18 publications

(9 citation statements)

References 196 publications

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“…Previous authors have hypothesized that the apparent increased susceptibility of normal organs with increasing age to chemotherapeutic agents may be multi-factorial with diminished organ function, altered pharmacokinetics or less effective tissue repair mechanisms all playing a role. [27][28][29] Interestingly, patients receiving an attenuated conditioning regimen did not suffer a significantly lower TRM than those who received full doses, possibly reflecting an increasing heterogeneity in patient tolerance to HDT with increasing age rather than a true lack of a dose-toxicity relationship. 27,29 This lack of significant correlation of TRM with dose could also be explained by both a tendency of clinicians to employ attenuated regimens with 'sicker' patients or simply a lack of statistical power.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of high-dose therapy and autologous hematopoietic stem cell transplantation for non-Hodgkin's lymphoma in adults 60 years of age and older

Gopal

Gooley

Golden

et al. 2001

Bone Marrow Transplant

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Summary:High-dose therapy (HDT) with autologous stem cell transplantation (ASCT) is the optimal treatment for patients with relapsed aggressive non-Hodgkin's lymphoma (NHL). HDT, however, is often reserved for relatively younger patients due to limited data in older adults. We treated 53 patients aged 60 years and older (median age 62 years, range 60.3-67.7 years) with HDT and ASCT for NHL at our centers. Forty-four patients (83%) had aggressive histology, 75% had chemosensitive disease and all had failed anthracycline therapy. Conditioning regimens included busulfan, melphalan, and thiotepa (45%); cyclophosphamide (CY), etoposide (VP-16), and total body irradiation (TBI) (30%); CY and TBI (15%); and other regimens (10%). Estimated 4-year overall survival (OS), progression-free survival, and treatment-related mortality (TRM) were 33%, 24% and 22%, respectively. A multivariable analysis demonstrated that patients with chemosensitive disease (P = 0.03) and р3 prior regimens (P = 0.03) had superior survival. Four-year OS in patients with chemosensitive disease was 39% vs 15% in patients with chemoresistant disease. Reduced TRM was associated with the CY, VP-16 and TBI regimen (P = 0.02). HDT therapy with ASCT may result in prolonged survival and potential cure for about a quarter of elderly patients, and for almost 40% with chemosensitive disease. Optimal conditioning regimen selection may further improve outcome by reducing TRM. Age alone should not be used to exclude patients from receiving myeloablative therapy with ASCT. Over 55 000 patients are diagnosed with non-Hodgkin's lymphoma (NHL) each year in the United States, with over 60% of these cases arising in persons over 60 years of age. 1 NHL is also one of the few malignancies that is increasing in incidence at a rate of 3-4% per year with the greatest increase in patients over 60 years old. 2 This cohort of older adults with NHL will be further augmented by the increase in the number of people over 60 from 12% today to a projected 20% of the US population by the year 2030. 3 Presently, an otherwise healthy 60 or 70 year old has a life expectancy of over 83 years, as reflected in this rise in the fraction of older adults. 4 Previous investigators have demonstrated that elderly patients with advanced aggressive NHL benefit from standard full-dose CHOP chemotherapy rather than a dosereduced version, although still less than one-third are cured with such primary treatment. 5 At the time of relapse, highdose therapy (HDT) followed by autologous stem cell transplantation (ASCT) has become the standard of care in younger patients, resulting in 20-50% long-term diseasefree survival (DFS). 6-11 Many clinicians, however, are reluctant to subject adults over the age of 60 to HDT for relapsed NHL because limited data are available on the efficacy of such therapy in this age group and because of concerns regarding toxicity. 12-15 We evaluated our experience in treating NHL patients over 60 years of age with HDT and ASCT. This report represents, to our knowledge, the lar...

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Section: Discussionmentioning

confidence: 99%

Efficacy of high-dose therapy and autologous hematopoietic stem cell transplantation for non-Hodgkin's lymphoma in adults 60 years of age and older

Gopal

Gooley

Golden

et al. 2001

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…37 Concerns about the generalizability from clinical trials research to the older-aged population, the age segment primarily affected by cancer, should be raised. [38][39][40][41][42][43] How can the evaluation of therapeutic options in clinical trials research, cancer control research, and epidemiologic investigations be made more pertinent to the majority of patients afflicted with colon carcinoma (i.e., the elderly)?…”

Section: Discussionmentioning

confidence: 99%