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Akhtar OS, Huang LW, Tsang M, Torka P, Loh KP, Morrison VA, Cordoba R. Geriatric assessment in older adults with Non-Hodgkin lymphoma: A Young International Society of Geriatric Oncology (YSIOG) review paper. J Geriatr Oncol 2022; 13:572-581. [PMID: 35216939 DOI: 10.1016/j.jgo.2022.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
Non-Hodgkin lymphoma (NHL) is a disease of older adults, with a median age at diagnosis of 67 years. Treatment in older adults with NHL is challenging. The aging process is associated with a decline in functional reserve that varies among individuals, and results in an increasing risk of treatment-related toxicity and mortality. Chronological age and performance status fail to capture the multidimensional and heterogeneous nature of the aging process. A geriatric assessment (GA) screens multiple geriatric domains and provides a more accurate assessment of functional reserve. Several abbreviated GA tools have been developed for use in oncology clinics and help identify patients at high risk for chemotherapy-related toxicity and mortality. In this review, we explore GA tools validated for use in patients with NHL. We discuss the evidence behind GA-guided treatment in NHL and present a suggested approach to assessing frailty in this patient population.
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Affiliation(s)
| | - Li-Wen Huang
- San Francisco VA Medical Center, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mazie Tsang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kah Poh Loh
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Vicki A Morrison
- Hennepin Healthcare/University of Minnesota, Minneapolis, MN, USA
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
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Giudice ID, Starza ID, Foà R. Does MRD have a role in the management of iNHL? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:320-330. [PMID: 34889425 PMCID: PMC8791119 DOI: 10.1182/hematology.2021000312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Among indolent non-Hodgkin lymphomas (iNHLs), the analysis of measurable/minimal residual disease (MRD) has been extensively applied to follicular lymphoma (FL). Treatment combinations have deeply changed over the years, as well as the techniques to measure MRD, which is currently evaluated only in the setting of clinical trials. Here, we discuss the evidence on the role of molecular monitoring in the management of FL. Mature data support the quantification of molecular tumor burden at diagnosis as a tool to stratify patients in risk categories and of MRD evaluation at the end of treatment to predict progression-free survival and overall survival. Moreover, MRD deserves further studies as a tool to refine the clinical/metabolic response and to modulate treatment intensity/duration. Patients with a higher relapse probability can be identified, but the relevance of continuous molecular follow-up should be clarified by kinetic models of MRD analysis. Being the BCL2/heavy chain immunoglobulin gene hybrid rearrangement detectable in about 50% to 60% of advanced FL and in 30% of positron emission tomography/computed tomography-staged localized FL, technical advancements such as next-generation sequencing/target locus amplification may allow broadening the FL population carrying a molecular marker. Droplet digital polymerase chain reaction can better quantify MRD at low levels, and novel sources of DNA, such as cell-free DNA, may represent a noninvasive tool to monitor MRD. Finally, MRD in other iNHLs, such as lymphoplasmacytic lymphoma/Waldenström macroglobulinemia and marginal zone lymphoma, is beginning to be explored.
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Affiliation(s)
- Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Ollila TA, Olszewski AJ. Chemotherapy-Free Management of Follicular and Marginal Zone Lymphoma. Cancer Manag Res 2021; 13:3935-3952. [PMID: 34017197 PMCID: PMC8131013 DOI: 10.2147/cmar.s267258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
Many patients with follicular (FL) or marginal zone lymphoma (MZL) are not eligible to receive immunochemotherapy due to advanced age or comorbidities. Recent innovations in the treatment of these indolent lymphomas provide options for multiple lines of chemotherapy-free management. More research is needed to determine which older patients are best served by a chemotherapy-free approach in the context of geriatric vulnerabilities. In the first line, regardless of disease burden, rituximab monotherapy can provide high rates of disease control with minimal toxicity, while judicious use of brief maintenance extends the duration of response. Radioimmunotherapy using ibritumomab tiuxetan is an effective and safe post-rituximab consolidation for older patients who have <25% bone marrow involvement. The combination of rituximab and lenalidomide, although “chemotherapy-free”, does not improve tolerability over immunochemotherapy. However, studies support lower doses and shorter duration of lenalidomide exposure as a means to improve safety without materially compromising efficacy for older individuals. Extranodal MZL can often be effectively controlled with low-dose radiation therapy, and splenic MZL has excellent outcomes with rituximab monotherapy. For many patients with relapsed FL/MZL, simple retreatment with anti-CD20 antibodies will prove sufficient. Other currently available options for relapsed/refractory disease include ibritumomab tiuxetan, lenalidomide with rituximab, umbralisib as a potentially less toxic PI3K inhibitor, ibrutinib (for MZL), and tazemetostat (for FL, especially with EZH2 mutation). Emerging data with novel forms of immunotherapy (antibody-drug conjugates like polatuzumab vedotin or loncastuximab tesirine; T-cell-engaging bispecific antibodies like mosunetuzumab or epcoritamab; and chimeric antigen receptor CAR T-cells like axicabtagene ciloleucel) suggest that immune-directed approaches can produce very high and potentially durable responses in FL/MZL with limited toxicities, further obviating the need for chemotherapy.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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Dogliotti I, Ragaini S, Vassallo F, Boccellato E, De Luca G, Perutelli F, Boccomini C, Clerico M, Botto B, Grimaldi D, Orsucci L, Ferrero S, Vitale C, Ferrero D, Coscia M, Cavallo F. Real Life Use of Bendamustine in Elderly Patients with Lymphoid Neoplasia. J Pers Med 2021; 11:jpm11040249. [PMID: 33808164 PMCID: PMC8066290 DOI: 10.3390/jpm11040249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Bendamustine is a cytotoxic alkylating drug with a broad range of indications as a single agent or in combination therapy in lymphoid neoplasia patients. However, its tolerability in elderly patients is still debated. METHODS An observational, retrospective study was carried out; patients with chronic lymphocytic leukemia (CLL) or lymphoma, aged ≥ 65 years old, treated with bendamustine-based regimens in first or subsequent lines between 2010 and 2020 were considered eligible. RESULTS Overall, 179 patients aged ≥ 65 years were enrolled, 53% between 71 and 79 years old. Cumulative Illness Rating Scale (CIRS) comorbidity score was ≥6 in 54% patients. Overall survival (OS) at 12 months was 95% (95% confidence interval [CI]: 90-97%); after a median follow up of 50 months, median OS was 84 months. The overall response rate was 87%, with 56% complete responses; the median time to progression (TTP) was 61 months. The baseline factors affecting OS by multivariable analysis were sex, histological diagnosis, renal function, and planned bendamustine dose, while only type of lymphoma and bendamustine dose impacted on TTP. Main adverse events were neutropenia (grade ≥ 3: 43%) and infections (any grade: 36%), with 17% of patients requiring hospital admission. CONCLUSIONS The responses to bendamustine, as well as survival, are relevant even in advanced age patients, with a manageable incidence of acute toxicity.
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Affiliation(s)
- Irene Dogliotti
- Stem Cell Transplant Unit, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Simone Ragaini
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Francesco Vassallo
- Division of Hematology, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (F.V.); (C.B.); (B.B.); (L.O.)
| | - Elia Boccellato
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Gabriele De Luca
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Francesca Perutelli
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Carola Boccomini
- Division of Hematology, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (F.V.); (C.B.); (B.B.); (L.O.)
| | - Michele Clerico
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Barbara Botto
- Division of Hematology, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (F.V.); (C.B.); (B.B.); (L.O.)
| | - Daniele Grimaldi
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Lorella Orsucci
- Division of Hematology, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (F.V.); (C.B.); (B.B.); (L.O.)
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Candida Vitale
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Dario Ferrero
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Marta Coscia
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Federica Cavallo
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
- Correspondence: ; Tel.: +39-01-1633-4556; Fax: +39-01-1633-6507
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