51
|
Chaganti S, Illidge T, Barrington S, Mckay P, Linton K, Cwynarski K, McMillan A, Davies A, Stern S, Peggs K. Guidelines for the management of diffuse large B-cell lymphoma. Br J Haematol 2016; 174:43-56. [PMID: 27196701 DOI: 10.1111/bjh.14136] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
MESH Headings
- Humans
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/therapeutic use
- Disease Management
- Doxorubicin/therapeutic use
- Frailty/therapy
- HIV Infections/complications
- HIV Infections/therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/therapy
- Prednisone/therapeutic use
- Rituximab
- Salvage Therapy/methods
- United Kingdom
- Vincristine/therapeutic use
Collapse
Affiliation(s)
- Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Tim Illidge
- Department of Clinical Oncology, Christie Hospital, Manchester, UK
| | - Sally Barrington
- PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Pam Mckay
- Department of Haematology, West of Scotland Cancer Centre, Glasgow, UK
| | - Kim Linton
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - Kate Cwynarski
- Department of Haematology, Royal Free Hospital, London, UK
| | | | - Andy Davies
- Department of Medical Oncology, Southampton General Hospital, Southampton, UK
| | - Simon Stern
- Department of Haematology, St Helier Hospital, Carshalton, UK
| | - Karl Peggs
- Department of Haematology, University College Hospital, London, UK
| |
Collapse
|
52
|
Huisingh-Scheetz M, Walston J. How should older adults with cancer be evaluated for frailty? J Geriatr Oncol 2016; 8:8-15. [PMID: 27318797 DOI: 10.1016/j.jgo.2016.06.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/21/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
Traditionally used as a descriptive term, frailty is now a recognized medical syndrome identifying individuals with decreased physiologic reserve. Frailty is characterized by diminished strength, endurance, and reduced physiologic function. Several valid frailty screening tools exist in the literature, and these measures have been used to relate frailty to outcomes important to the older patient with cancer. Frail adults are at increased risk of adverse surgical outcomes and early findings suggest that frailty predicts poor chemotherapy tolerance. While much research is needed to explore the biologic relationships between frailty and cancer, there is an urgent need to implement frailty screening and management into the care of the older patient with cancer in order to improve outcomes in this vulnerable subset. The purpose of this paper is to provide an introduction of frailty to oncologists including a review of the definition, frailty screening tools, its clinical relevance to older patients with cancer, and a brief guide to frailty management.
Collapse
Affiliation(s)
| | - Jeremy Walston
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, USA
| |
Collapse
|
53
|
Hamaker ME, Augschoell J, Stauder R. Clinical judgement and geriatric assessment for predicting prognosis and chemotherapy completion in older patients with a hematological malignancy. Leuk Lymphoma 2016; 57:2560-7. [PMID: 27050121 DOI: 10.3109/10428194.2016.1163345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prior research has focused on comparing clinical judgment with geriatric assessments in identifying potentially unfit patients or the prognostic value of geriatric impairments. In this study, we set out to compare and combine geriatric impairments with clinical judgment in predicting mortality and non-completion of chemotherapy in older patients with a hematological malignancy. Between March 2004 and August 2014, a multi-dimensional geriatric assessment was performed in consecutive patients aged ≥65 years diagnosed with a hematological malignancy at the Innsbruck university hospital. Associations between geriatric assessment, clinical judgment (derived from initial treatment decision) and outcome (mortality, non-completion) were analyzed. Patient sample consisted of 157 patients, of which 37% was 80 + years of age. Aggressive non-Hodgkin lymphoma (29%), acute myeloid leukemia (27%) and myelodysplastic syndromes (20%) were most common diagnoses. Prevalence of an impaired geriatric assessment (i.e. impairments in ≥2 of eight assessed domains) was 71% and similar for patients receiving standard (71%) or attenuated treatment (72%). Clinical judgment was the strongest predictor of mortality (p = 0.003); addition of geriatric assessment allowed for further stratification of patients with a good (>75% one year survival), intermediate (50-60%) and poor prognosis (<30%). Cumulative burden of geriatric impairments further increased risk of mortality. Clinical judgment was greatly superior to geriatric assessment in identifying patients at risk for non-completion. The combination of clinical judgment and geriatric assessment allows for better prognostic stratification of patients compared to clinical judgment alone.
Collapse
Affiliation(s)
- M E Hamaker
- a Department of Geriatric Medicine , Diakonessenhuis , Utrecht , the Netherlands
| | - J Augschoell
- b Department of Internal Medicine V (Hematology and Oncology) , Innsbruck Medical University , Innsbruck , Austria
| | - R Stauder
- b Department of Internal Medicine V (Hematology and Oncology) , Innsbruck Medical University , Innsbruck , Austria
| |
Collapse
|
54
|
Socioeconomic Considerations and Shared-Care Models of Cancer Care for Older Adults. Clin Geriatr Med 2016; 32:35-44. [DOI: 10.1016/j.cger.2015.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
55
|
Millar A, Ellis M, Mollee P, Cochrane T, Fletcher J, Caudron A, Webster B, Trotman J. Deliverability and efficacy of R-CHOP chemotherapy in very elderly patients with diffuse large B-cell lymphoma: an Australian retrospective analysis. Intern Med J 2015; 45:1147-53. [DOI: 10.1111/imj.12889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/09/2015] [Indexed: 12/26/2022]
Affiliation(s)
- A. Millar
- University of Sydney; Sydney New South Wales Australia
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - M. Ellis
- Princess Alexandra Hospital; Brisbane Queensland Australia
| | - P. Mollee
- Princess Alexandra Hospital; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - T. Cochrane
- Gold Coast University Hospital; Gold Coast Queensland Australia
| | - J. Fletcher
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - A. Caudron
- Princess Alexandra Hospital; Brisbane Queensland Australia
| | - B. Webster
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - J. Trotman
- University of Sydney; Sydney New South Wales Australia
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| |
Collapse
|
56
|
Comprehensive geriatric assessment in elderly patients with newly diagnosed aggressive non-Hodgkin lymphoma treated with multi-agent chemotherapy. J Geriatr Oncol 2015; 6:470-8. [DOI: 10.1016/j.jgo.2015.10.183] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/23/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022]
|
57
|
Fabbri A, Cencini E, Bocchia M. Treatment decisions and outcome in very elderly patients with diffuse large B-cell lymphoma. Cancer 2015; 121:3746-7. [PMID: 26110422 DOI: 10.1002/cncr.29509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alberto Fabbri
- Hematology Unit, University Medical Center, Siena, Italy
| | - Emanuele Cencini
- Hematology Unit, University Medical Center; University of Siena, Siena, Italy
| | - Monica Bocchia
- Hematology Unit, University Medical Center; University of Siena, Siena, Italy
| |
Collapse
|
58
|
Yoshida M, Nakao T, Horiuchi M, Ueda H, Hagihara K, Kanashima H, Inoue T, Sakamoto E, Hirai M, Koh H, Nakane T, Hino M, Yamane T. Analysis of elderly patients with diffuse large B-cell lymphoma: aggressive therapy is a reasonable approach for 'unfit' patients classified by comprehensive geriatric assessment. Eur J Haematol 2015; 96:409-16. [PMID: 26084899 DOI: 10.1111/ejh.12608] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The treatment strategy for diffuse large B-cell lymphoma (DLBCL) in elderly patients is problematic. Although several researchers have reported the effectiveness of comprehensive geriatric assessment (CGA) and the futility of curative treatment in 'unfit' patients with DLBCL, these propositions are not firmly established. PATIENTS AND METHODS We conducted a retrospective analysis using a database. Patients with DLBCL were eligible if ≧ 60 yr old. CGA stratification was performed using medical records. RESULTS One hundred and 35 patients were identified. Anthracycline-based chemotherapy with curative intent was performed in 115 (85%) patients. According to CGA, 82 (61%) patients were classified as 'fit'. Their 1-yr overall survival (OS) was significantly better than that of 'unfit' patients [91.3% vs. 53.8%, P < 0.001]. Patients classified as 'unfit' treated with curative intent had a significantly better 1-yr OS when compared with those receiving palliative measures [66.1% vs. 19.0%, P < 0.001]. CONCLUSIONS CGA is an effective tool for predicting outcomes in older patients with DLBCL. The patients treated with curative intent had significantly better outcomes compared with those receiving palliation, irrespective of CGA stratification. Curative treatment should be considered even for 'unfit' patients.
Collapse
Affiliation(s)
- Masahiro Yoshida
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Takafumi Nakao
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Mirei Horiuchi
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Hideya Ueda
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Kiyoyuki Hagihara
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Hiroshi Kanashima
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Erina Sakamoto
- Department of Haematology, Shitennoji Hospital, Osaka, Japan
| | - Manabu Hirai
- Department of Haematology, Shitennoji Hospital, Osaka, Japan
| | - Hideo Koh
- Department of Haematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takahiko Nakane
- Department of Haematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masayuki Hino
- Department of Haematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takahisa Yamane
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| |
Collapse
|
59
|
Factors that influence treatment decision-making in elderly DLBCL patients: a case vignette study. Ann Hematol 2015; 94:1373-9. [PMID: 25869027 PMCID: PMC4488461 DOI: 10.1007/s00277-015-2358-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/18/2015] [Indexed: 10/26/2022]
Abstract
Elderly patients with diffuse large B-cell lymphoma (DLBCL) are frequently not treated with standard immunochemotherapy, and this influences survival negatively. The purpose of this study was to gain more insight into treatment decision-making by hematologists. Case vignettes concerning patients with DLBCL were presented to hematologists in the Netherlands. Patient characteristics (age, comorbidity) differed per case. Respondents were asked in each case if they would treat the patient with curative intent by means of full-dose chemotherapy or chemotherapy with dose reduction or if they would not treat the patient with curative intent. The vast majority of respondents would treat an elderly patient diagnosed with DLBCL without a relevant medical history with full-dose chemotherapy irrespective of age. In the presence of comorbidity, lack of social support, cognitive disorders, and untreated depression dose reductions in advance are frequently applied or patients are not treated with curative intent. This is most pronounced for patients aged older than 80 years. Respondents working in a university hospital more frequently refrain form full-dose chemotherapy with curative intent compared to respondents working in tertiary medical teaching hospitals or general hospitals. Patients without a relevant medical history are generally treated with curative intent irrespective of age. Cognitive disorders, comorbidity, and depression reduce the change of being treated with curative intent. This is most prominent in the eldest patient category.
Collapse
|
60
|
Terret C, Albrand G, Rainfray M, Soubeyran P. Impact of comorbidities on the treatment of non-Hodgkin’s lymphoma: a systematic review. Expert Rev Hematol 2015; 8:329-41. [DOI: 10.1586/17474086.2015.1024650] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
61
|
Tucci A, Martelli M, Rigacci L, Riccomagno P, Cabras MG, Salvi F, Stelitano C, Fabbri A, Storti S, Fogazzi S, Mancuso S, Brugiatelli M, Fama A, Paesano P, Puccini B, Bottelli C, Dalceggio D, Bertagna F, Rossi G, Spina M. Comprehensive geriatric assessment is an essential tool to support treatment decisions in elderly patients with diffuse large B-cell lymphoma: a prospective multicenter evaluation in 173 patients by the Lymphoma Italian Foundation (FIL). Leuk Lymphoma 2014; 56:921-6. [DOI: 10.3109/10428194.2014.953142] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
62
|
What determines therapeutic choices for elderly patients with DLBCL? Clinical findings of a multicenter study in Portugal. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:370-9. [PMID: 24629852 DOI: 10.1016/j.clml.2014.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/15/2014] [Accepted: 01/23/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Age is a negative prognostic factor in lymphomas, and elderly patients are often undertreated because of toxicity concerns. The pattern of treatment in elderly patients with diffuse large B-cell lymphoma (DLBCL) in Portugal has not been previously described. PATIENTS AND METHODS We conducted a multicenter retrospective study including 378 elderly patients with DLBCL receiving alkylating agent-containing regimens between 2003 and 2010. We compared the outcome of patients aged 60 to 79 years with patients > 79 years and analyzed the second group according to treatment. RESULTS R-CHOP (rituximab, cyclophosphamide, doxorubicin [hydroxydaunorubicin], vincristine [Oncovin], prednisolone) was prescribed in only 60% of patients and was prescribed significantly less in patients > 79 years, despite no significant differences being found in comorbidities between the 2 age groups. Similarly, dose reductions frequently were instituted because of chronologic age and not always because of toxicity. When different regimens were compared, multivariate analysis showed an independent beneficial effect of R-CHOP in treatment outcomes. Additionally, treatment with anthracyclines and rituximab predicted a better progression-free survival (PFS) and time to progression (TTP) in patients > 79 years. CONCLUSION This was the first characterization of the clinical care of elderly Portuguese patients with DLBCL. We showed that R-CHOP is effective even in patients > 79 years, emphasizing that treatment decisions based on age alone can compromise treatment efficacy and outcome in fit patients.
Collapse
|
63
|
Wildes TM, Goede V, Hamlin P. Personalizing therapy for older adults with lymphoid malignancies: options and obstacles. Am Soc Clin Oncol Educ Book 2014:e240-e248. [PMID: 24857108 DOI: 10.14694/edbook_am.2014.34.e240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Increasing age is both a risk factor for and a negative prognostic factor in lymphoid malignancies. The disparities in outcomes between older and younger adults with lymphoid malignancies may reflect age-related differences in treatment and in biology of disease. Lymphomas in older adults are biologically more aggressive. Only small age-related differences in the frequency of cytogenetic abnormalities are seen in multiple myeloma. No major differences in the biology of chronic lymphocytic leukemia (CCL) are seen across the age spectrum. Chemotherapy and immunotherapy in older adults with lymphoid malignancies are marked by greater vulnerability to toxicity of therapy. Excessive toxicity can result in poorer outcomes, either directly through treatment-related mortality, or through decreased dose intensity. Thus, new approaches to predict toxicity of therapy and stratified treatment algorithms based on risk of toxicity are needed. Herein we detail some of the promising approaches to predicting toxicity and tailoring treatment for older adults with lymphoid malignancies.
Collapse
Affiliation(s)
- Tanya M Wildes
- From the Washington University School of Medicine, St. Louis, MO; University Hospital, Cologne, Germany; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valentin Goede
- From the Washington University School of Medicine, St. Louis, MO; University Hospital, Cologne, Germany; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Hamlin
- From the Washington University School of Medicine, St. Louis, MO; University Hospital, Cologne, Germany; Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|