Treatment of non-Hodgkin's lymphoma in the elderly: an update

Tirelli, Umberto; Zagonel, Vittorina; Errante, D.; Fratino, Lucia; Monfardini, S.

doi:10.1002/(sici)1099-1069(1998030)16:1<1::aid-hon617>3.0.co;2-7

Cited by 13 publications

(5 citation statements)

References 40 publications

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“…Although there is a strict selection for chemotherapy for elderly patients with aggressive NHL, we found that elderly patients who received chemotherapy suffered from cardiovascular complications more frequently than younger patients. The same was found in previous clinical trials (Bastion et al , 1997; Gomez et al , 1998; Tirelli et al , 1998; Zinzani et al , 1999; Balducci & Repetto, 2004). In addition, grade III/IV toxicity was observed more frequently in patients with a higher IPI score.…”

Section: Discussionsupporting

confidence: 89%

“…We did not find a significant influence of severity of comorbidity on the application of chemotherapy, except for cardiovascular comorbidity. Among patients with aggressive NHL receiving chemotherapy, the proportion receiving CHOP‐like therapy was lower among the elderly, whereas this is presumably the only chance for cure of these patients (Tirelli et al , 1998; Lee et al , 2003). In our study, the dose of chemotherapy did not appear to be reduced significantly more often in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

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A population‐based study of severity of comorbidity among patients with non‐Hodgkin's lymphoma: prognostic impact independent of International Prognostic Index

et al. 2005

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SummaryOver 60% of patients aged over 70 years, diagnosed with non-Hodgkin's lymphoma (NHL) in the Netherlands have serious comorbidity. We studied the independent influence of comorbidity on choice of treatment, dose reductions, treatment-related toxicity and prognosis, using data from a random sample of 381 patients from the population-based Eindhoven Cancer Registry. About 45% of patients over 60 years of age with NHL had high impact comorbidity at the time of cancer diagnosis. The proportion of patients with aggressive NHL who received chemotherapy decreased from 85% in patients aged 40-60 years to 70% in those over 60 years. About 65% of systematically treated patients with aggressive NHL suffered from treatment-related toxicity. Toxicity appeared to be more common among females and those with high-intermediate or high International Prognostic Index (IPI) risk. Among patients with aggressive NHL, the chance of dying for those with high impact comorbidity was twice as high compared with those without comorbidity. This was independent of the IPI risk. Dose reductions are frequently unavoidable for patients with severe comorbidity, poor performance status or chemotherapy-related toxicity. Whether the less frequent prescription of (full dose) chemotherapy for patients with advanced age and/or with comorbidity is justified remains a question for debate.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

A population‐based study of severity of comorbidity among patients with non‐Hodgkin's lymphoma: prognostic impact independent of International Prognostic Index

et al. 2005

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“…Haematological malignancies are a heterogeneous group of diseases affecting all age groups (Tirelli et al , 1998; Adami et al , 2002; Zinzani, 2005). With the exception of Hodgkin disease and acute lymphoblastic leukaemia, incidence rates of the different types of haematological malignancies increase with advancing age (McNally et al , 1997).…”

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confidence: 99%

Short‐term mortality of bacteraemia in elderly patients with haematological malignancies

et al. 2005

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Summary Bacterial infections are important complications in patients with haematological malignancies. We compared the outcome of bacteraemia among elderly and younger patients with haematological malignancies, and evaluated the impact of comorbidity on this association using population‐based registries from 1992 to 2002. Among 358 patients with an incident haematological malignancy and an episode of bacteraemia, 207 (58%) were older than 60 years and 37 (10%) older than 80 years. The 7‐d mortality was 10% among patients younger than 60 years, 21% among patients aged 60–79 years, and 27% for patients older than 80 years. When compared with patients younger than 60 years, the adjusted mortality rate ratios (MRRs) were 1·9 [95% confidence interval (CI): 0·9–3·8] for patients aged 60–79 years and 1·6 (95% CI: 0·6–4·2) for patients older than 80 years. The 30‐d mortality was 23% among patients younger than 60 years of age, 35% among patients aged 60–79 years, and 54% among patients 80 years or older. Adjusted MRRs were 1·7 (95% CI: 1·1–2·7) and 2·3 (95% CI: 1·2–4·3), respectively. We found that increasing age was associated with increased mortality from bacteraemia in patients with haematological malignancies. An increased burden of comorbidity among the elderly did not explain this association.

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“…Different studies have shown that older patients benefit from aggressive treatment and should be treated similarly to younger patients, with the intent to cure [57]. Once complete remission has been achieved, the disease-free survival is not different between younger and older adults [58].…”

Section: Hematological Malignanciesmentioning

confidence: 99%

“…The prophylactic use of bone marrow-stimulating factors has reduced the incidence, severity and duration of chemotherapy-induced leucopenia and anemia. The cost-effectiveness of these medications has been demonstrated [58].…”

Section: Hematological Malignanciesmentioning

confidence: 99%

Cancer in older men: A gender-based review

Cepeda

Gammack

2006

The Aging Male

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Cancer is a common condition of the older male. Risk factors for developing a malignancy include genetic, environmental and life style features. Cancer epidemiology and prognosis differ depending on the age and gender of the population being studied. In the group of men older than 65 years, the most common malignant tumors are prostate, lung, colon and pancreatic cancer. Treatment options vary depending on the stage of the tumor when it is diagnosed, and the decision for therapeutic versus palliative interventions will depend upon the functional status, comorbidity and personal wishes of the patients.

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Treatment of non-Hodgkin's lymphoma in the elderly: an update

Cited by 13 publications

References 40 publications

A population‐based study of severity of comorbidity among patients with non‐Hodgkin's lymphoma: prognostic impact independent of International Prognostic Index

A population‐based study of severity of comorbidity among patients with non‐Hodgkin's lymphoma: prognostic impact independent of International Prognostic Index

Short‐term mortality of bacteraemia in elderly patients with haematological malignancies

Cancer in older men: A gender-based review

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