ESMO Consensus Conference on malignant lymphoma: general perspectives and recommendations for the clinical management of the elderly patient with malignant lymphoma

Abstract

The European Society for Medical Oncology (ESMO) consensus conference on mature B cell lymphomas and chronic lymphocytic leukaemia (CLL) was held on 20 June 2015 in Lugano, Switzerland, and included a multidisciplinary panel of 25 leading experts. The aim of the conference was to develop recommendations on critical subjects difficult to consider in detail in the ESMO Clinical Practice Guidelines. The following areas were identified: (1) the elderly patient, (2) prognostic factors suitable for clinical use, and (3) the 'ultra-high-risk' group. Before the conference, the expert panel was divided into three working groups; each group focused on one of these areas in order to address clinically-relevant questions relating to that topic. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, each working group developed recommendations to address each of the four questions assigned to their group. These recommendations were presented to the entire panel and a consensus was reached. This consensus, which was further developed in continuous post-meeting discussions, formed the basis of three manuscripts, each covering one of the three key areas identified. This manuscript presents the consensus recommendations regarding the clinical management of elderly patients diagnosed with malignant lymphoma. Four clinically-relevant topics identified by the panel were: 1) how to define patient fitness, 2) assessing quality of life, 3) diagnostic work-up and 4) clinical management of elderly patients with lymphoma. Each of these key topics is addressed in the context of five different lymphoma entities, namely: CLL, follicular lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma and diffuse large B-cell lymphoma. Results, including a summary of evidence supporting each recommendation, are detailed in this manuscript.

Impact of intended and relative dose intensity of R‐CHOP in a large, consecutive cohort of elderly diffuse large B‐cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age

“…Our data suggest that this balance is best retained by an IDI (and subsequent RDI as it is relatively uncommon to alter IDI) of approximately 50% in patients ≥80 years, that is R-mini-CHOP. This conclusion is consistent with previously published data [14] and recent ESMO guidelines for managing elderly DLBCL [18].…”

Expression of molecules of the Wnt pathway and of E‑cadherin in the etiopathogenesis of human thymomas

“…Along with that, thymomas of younger patients were less invasive and showed lower recurrence rate in our study. Thus, similar to other malignancies of lymphoreticular organs (6,37), the age over 60 years seems to be a negative prognostic factor also in thymomas. The increased size of non-myasthenic thymomas is probably due to delayed manifestation of these tumors with the absence of the MG and corresponds to higher age at manifestation.…”

Obinutuzumab and miniCHOP for unfit patients with diffuse large B-cell lymphoma. A phase II study by Fondazione Italiana Linfomi

“…Combination of rituximab with full dose CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy is the undisputed standard treatment for all patients, including elderly subjects, but it is not usually prescribed in patients who are older than 80 years or in those who are not fit enough to receive full dose chemotherapy. An attenuated version of R-CHOP, namely R-miniCHOP, has been recommended as standard regimen for patients older than 80 years based on the positive results of a large phase II study [1,2]. Obinutuzumab (Ga101) is a glycoengineered, type II anti-CD20 monoclonal antibody with greater direct cell death induction and antibody-dependent cellular cytotoxicity and phagocytosis than rituximab [3].…”