Treatment decisions for elderly patients with haematological malignancies: a dilemma

Peyrade, Fréd́eric; Gastaud, Lauris; Ré, Daniel; Pacquelet-Cheli, Sandrine; Thyss, Antoine

doi:10.1016/s1470-2045(12)70234-6

Cited by 39 publications

(32 citation statements)

References 76 publications

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“…11 This trial confirmed the feasibility and efficacy (49% OS at 4 years) of this reduced R-CHOP in very old patients, as reported also in retrospective studies. 12 However, this population was also selected on the basis of comorbidities and an interesting retrospective study reported by Marchesi et al showed that "frail" patients [aged 85 years or over, activities of daily living (ADL) < 6, 1 geriatric syndrome or > 3 comorbidities] did not benefit from any chemotherapy.…”

Section: Disease-related Problemssupporting

confidence: 83%

Unmet needs in the scientific approach to older patients with lymphoma

et al. 2017

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Section: Disease-related Problemssupporting

confidence: 83%

Unmet needs in the scientific approach to older patients with lymphoma

et al. 2017

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“…A recent review point out this dilemma in hematologic malignancies28 but data are very scarce for HL. A range of techniques have been advanced for assessing geriatric patients with a view to singling out those capable of receiving a potentially toxic dose of chemotherapy.…”

Section: Role Of Geriatric and Comorbidity Assessment In The Treatmenmentioning

confidence: 99%

Hodgkin Lymphoma in Older Patients: An Orphan Disease?

Thyss¹,

Saâda²,

Gastaud³

et al. 2014

Mediterr J Hematol Infect Dis

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Hodgkin Lymphoma HL can be cured in the large majority of younger patients, but prognosis for older patients, especially those with advanced-stage disease, has not improved substantially. The percentage of HL patients aged over 60 ranges between 15% and 35%. A minority of them is enrolled into clinical trials. HL in the elderly have some specificities: more frequent male sex, B-symptoms, advanced stage, sub diaphragmatic presentation, higher percentage of mixed cellularity, up to 50% of advanced cases associated to EBV. Very old age (>70) and comorbidities are factor of further worsening prognosis. Like in younger patients, ABVD is the most used protocol, but treatment outcome remains much inferior with more frequent, severe and sometimes specific toxicities. Few prospective studies with specific protocols are available. The main data have been published by the Italian Lymphoma Group with the VEPEMB schedule and the German Hodgkin Study Group with the PVAG regimen. Recently, the Scotland and Newcastle Lymphoma Study Group published the SHIELD program associating a prospective phase 2 trial with VEPEMB and a prospective registration of others patients. Patients over 60y with early-stage disease received three cycles plus radiotherapy and had 81% of 3-year overall survival (OS). Those with advanced-stage disease received six cycles, with 3-year OS of 66%. The role of geriatric and comorbidity assessment in the treatment’s choice for HL in the elderly is a major challenge. The combination of loss of activities of daily living combined with the age stratification more or less 70y has been shown as a simple and effective survival model. Hopes come from promising new agents like brentuximab-vedotin (BV) a novel antibody-drug conjugate. The use of TEP to adapt the combination of chemotherapy and radiotherapy according to the metabolic response could also be way for prospective studies.

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“…The CGA is a tool developed by geriatricians to evaluate the elderly exploring the functional status, emotional conditions, social support, nutritional status, polypharmacy and the presence of geriatric syndromes [9]. With the data provided by the CGA, oncologists possess relevant information about the physiological status of the patient, which helps to avoid subjective decisions of who should or should not be treated based only on chronological age.…”

Section: Discussionmentioning

confidence: 99%

“…In the study of Peyrade et al [4], R-mini-CHOP in elderly patients was associated with a 6% rate of serious cardiac adverse events. Additional data shows that the risk of developing congestive heart failure after 8 years for an elderly patient receiving an anthracycline dose of 25–35 mg/m 2 per cycle, repeated for 6 cycles, is only marginal [9]. Nevertheless, our patient developed congestive heart failure, functional class II, although we cannot warrant that it was strictly related to doxorubicin, given other concomitant risk factors were also present (long-lasting hypertension, chronic arterial vasculopathy, end-stage renal disease and radiotherapy).…”

Section: Discussionmentioning

confidence: 99%

“…For example, in a prospective study conducted by Soubeyran et al [15], COP was associated with only 18.5% of complete responses. Indeed, when planning the chemotherapy regimen, it is essential to question if there really is any contraindication to the use of CHOP-based regimens, as patients not treated with CHOP have a worse survival and a higher death rate from lymphoma [9]. …”

Section: Discussionmentioning

confidence: 99%

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Treatment of a Frail Older Patient with Diffuse Large B-Cell Lymphoma on Maintenance Dialysis: Attenuated Immunochemotherapy and Adapted Care Plan

Pontes¹,

Todaro

Karnakis

et al. 2013

Case Rep Oncol

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Purpose of the Study: Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy worldwide. Its incidence increases with age and about 40% of cases occur in patients over 70 years. Herein, we describe a case of a frail elderly patient with renal insufficiency and DLBCL treated with R-mini-CHOP. Case Report: A 77-year-old man on maintenance hemodialysis started experiencing persistent fatigue. He was diagnosed with a large mass on the left lobe of the lung. Biopsy demonstrated a DLBCL, CD20 positive. The patient was assigned clinical stage IIBX, with a high age-adjusted international prognosis index. A proper geriatric assessment revealed a frail patient. Thus, an adapted chemotherapy regimen was proposed which consisted of R-mini-CHOP every 21 days, with a reduction of 10% in the doses of doxorubicin and cyclophosphamide. During the treatment, the patient went through regular dialysis sessions, 3 times per week, with an extra session performed 12 h after each chemotherapy administration. The patient experienced no adverse events or grade 3/4 toxicities. After 6 cycles of R-mini-CHOP, the patient achieved unconfirmed complete remission, and consolidation radiotherapy was performed. At the last follow-up, he was still in unconfirmed complete remission, with a progression-free survival of 11.3 months. Conclusions: R-mini-CHOP represented a reasonable treatment option for this patient with renal failure. The oncogeriatric approach led to a successful management of this frail patient, highlighting that an adapted plan of care is a key issue to improve the outcomes of elderly cancer patients.

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Treatment decisions for elderly patients with haematological malignancies: a dilemma

Cited by 39 publications

References 76 publications

Unmet needs in the scientific approach to older patients with lymphoma

Unmet needs in the scientific approach to older patients with lymphoma

Hodgkin Lymphoma in Older Patients: An Orphan Disease?

Treatment of a Frail Older Patient with Diffuse Large B-Cell Lymphoma on Maintenance Dialysis: Attenuated Immunochemotherapy and Adapted Care Plan

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