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PubMed: CHOP
+ Rituxan | General: ASCO |
Medscape
| Web
 Elderly
patients diagnosed with lymphoma may have special needs. The
good news is that recent evidence suggest that they will often
tolerate and respond very well to treatment. Adjustment to
treatments may be indicated based on health and performance
status.
... "It has been noted that an
80-year-old in the upper quartile of health based
on a geriatric
assessment has a similar life expectancy to that of a
70-year-old in
a middle quartile."
... "Important issues that should
be highlighted include: (1) information gained from a comprehensive
assessment of the health status of the patient, including comorbidity,
performance status and functional status, and quality
of life that can be used to evaluate and guide management decisions,
and (2) unanswered questions that need to be explored in future
research."
... "A significant ongoing effort is
aimed at determining the feasibility of a cancer-specific geriatric
assessment and whether such an assessment affects treatment toxicity
and outcome.[1] Clearly, the most challenging goal is to segregate
frail older lymphoma patients from a healthier cohort."
Non-Hodgkin's Lymphoma in the Elderly cancernetwork.com
(free login required)
Further Considerations About NHL in the
Elderly
Issues
Issues and risks of treatment must be weighed
against the risk of the disease un-treated. For example, a smaller chance
of curing DLBCL because of advanced age or poor performance could be better than
the risk of allowing the disease to progress unchecked. It's our
expectation that the oncology team will take these and other factors into
consideration when developing a treatment or management plan for you or your loved one.
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Comorbidities (secondary conditions)
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Performance status (frailty or vitality)
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Cardiac function (strong or compromised)
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Renal (kidney) and Hepatic (liver) function - can affect
ability to tolerate full dose
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Risk of treatment-related toxicities (generally increasing
with age and decreased performance)
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Ability to tolerate full dose (generally increasing with
age and decreased performance)
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cure/remission rates (generally decreasing with age and
decreased performance)
Adapted from Non-Hodgkin's
Lymphoma in the Elderly
Part 2: Treatment of Diffuse Aggressive Lymphomas
cancernetwork.com
(login may be required)
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Abstract and Resources
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Non-Hodgkin's Lymphoma in the Elderly
Part 1: Overview and Treatment of
Follicular Lymphoma
- cancernetwork.com
(login may be required)
Vicki A. Morrison, MD Associate Professor of
Medicine University of Minnesota
Clinical care of the older cancer patient is complicated by a
variety of factors (Table 1). Clearly, chronologic age alone is not
sufficient to categorize these patients.[15] The issue of "ageist
stereotyping" may be present among physicians, patients, and
family members.
Non-Hodgkin's Lymphoma in the Elderly
Part 2: Treatment of Diffuse Aggressive
Lymphomas cancernetwork.com
(login may be required)
The majority of patients with diffuse aggressive NHL have
advanced-stage disease, regardless of age. Therapy with CHOP for many
years was the standard regimen for these patients, with cure rates of
25% to 30%, compared to 50% to 60% of younger patients, and a toxic
death rate of 1%.
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| ASCO 2003: Older Patients Less Likely to be Referred to
Oncologists, Participate in Clinical Trials PLWC
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| Management of Cancer in the Elderly, Lodovico
Balducci, MD, and Martine Extermann, MD theoncologist
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| Non-Hodgkin's Lymphoma in the Elderly, moffitt.usf.edu
PDF
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| Treatment
for the Older Non-Hodgkin Lymphoma Patient, Dr. John Leonard, M.D.
LLS PDF (10/19/04)
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Outcome data - specific protocols
| Combo Therapy with Tositumomab (Bexxar) and
Auto SCT Aids Elderly Lymphoma Patients cancerpage
"These data suggest that potentially curative therapies
should not be denied to patients based solely on age," lead
investigator Dr. Ajay K. Gopal of the University of Washington,
Seattle, told Reuters Health. "In addition, targeted
therapies with individualized dosing strategies, as in this study,
may prove useful to both reduce toxicity and improve outcomes in
patients of all ages."
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| CHOP chemotherapy plus rituximab compared with
CHOP alone in elderly patients with diffuse large-B-cell lymphoma.
N Engl J Med. 2002 Jan 24;346(4):235-42. PMID:
11807147
The addition of rituximab to the CHOP regimen increases the
complete-response rate and prolongs event-free and overall
survival in elderly patients with diffuse large-B-cell lymphoma,
without a clinically significant increase in toxicity.
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| Short Course of Rituxan®/Chemotherapy Plus Maintenance Rituxan® Provides High Progression-Free Survival as Initial Treatment Diffuse B-Cell NHL Among Patients Ineligible for Standard R-CHOP
cancerconsultants.com
31% achieved a complete disappearance of detectable cancer
(complete response)
38% achieved a partial regression of their cancer (partial
response)
Disease stabilization was achieved in 31%
No patient experienced disease progression
Progression-free survival at both one and two years was 92%
Treatment was well tolerated, with low levels of immune cells
being the most common side effect
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| Hodgkin's lymphoma in the elderly: The results
of 10 years of follow-up.
Leuk Lymphoma. 2006 Aug;47(8):1518-22. PMID:
16966262
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| Outcomes and diffusion of doxorubicin-based
chemotherapy among elderly patients with aggressive non-Hodgkin
lymphoma. Cancer. 2006 Aug 24; PMID:
16933332
Conclusions.: By 1999, doxorubicin-based chemotherapy had
gained general acceptance for use among the elderly, although
nearly 50% of elderly patients still were not receiving it. Given
the clinical trial-based evidence of its benefits, in the absence
of specific contraindications, most patients, including the
elderly, should be treated with regimens that include doxorubicin.
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| A Brief Course of Chemo-Immunotherapy
FND + Rituximab Is Effective To Induce a High Clinical and
Molecular Response In Elderly Patients With Advanced Stage
Follicular Lymphoma (FL) at Diagnosis. Session Type: Poster
Session 564-I ASH
2003
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| First-line treatment with brief-duration
chemotherapy plus rituximab in elderly patients with
intermediate-grade non-Hodgkin's lymphoma: phase II trial.
Clin Lymphoma. 2003 Jun; 4(1): 36-42. PMID:
12837153
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| A dexamethasone, vinblastine, cyclophosphamide,
etoposide, methotrexate and bleomycin (D-VICEMB) protocol as
first-line treatment of patients aged 70 years or older affected
by intermediate/high grade non-Hodgkin's lymphoma Medscape
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| Elderly Patients with Non-Hodgkin’s Lymphoma Tolerate
Autologous Stem Cell Transplantation cancerconsultants.com
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| Alternation of epirubicin and mitoxantrone in
CHOP-like regimens retains efficacy and reduces overall toxicity
in elderly patients with high and intermediate grade non-Hodgkin
lymphomas.
Leuk Lymphoma. 2002 Dec;43(12):2319-24. PMID:
12613518
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| Rituximab plus gemcitabine: a therapeutic
option for elderly or frail patients with aggressive non Hodgkin's
lymphoma? Leuk Lymphoma. 2005 Jan;46(1):71-5. PMID:
15621783
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| Rituximab Plus Chemo More Effective in Elderly Lymphoma Patients.
Updated 02/05/02 Cancer.gov
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| Rituximab plus gemcitabine: a therapeutic
option for elderly or frail patients with aggressive non Hodgkin's
lymphoma? Leuk Lymphoma. 2005 Jan;46(1):71-5. PMID:
15621783
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| Continuous infusion of vincristine-doxorubicin
with bolus of dexamethasone(VAD) alternated with CHEP in the
treatment of patients over 60 years old with aggressive
non-Hodgkin's lymphoma.
Leuk Lymphoma. 2001 Feb;40(5-6):529-40. PMID: 11426526 PubMed
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Low-dose fludarabine and cyclophosphamide
in elderly patients with B-cell chronic lymphocytic leukemia
refractory to conventional therapy. Haematologica. 2000
Dec;85(12):1268-70. PMID:
11114133
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| J Clin Oncol 1998 Jan;16(1):27-34 umbertotirelli
CHOP is the standard regimen in patients > or = 70 years
of age with intermediate-grade and high-grade non-Hodgkin's
lymphoma: results of a randomized study of the European
Organization for Research and Treatment of Cancer Lymphoma
Cooperative Study Group.
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| Treatment of large
cell lymphoma in elderly patients with a mitoxantrone,
cyclophosphamide, etoposide, and prednisone regimen: long-term
follow-up results. Cancer. 2003 Jan
1;97(1):97-104. Review.
PMID: 12491510 PubMed
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| A phase II study of liposomal vincristine in CHOP with rituximab for elderly patients with untreated aggressive B-cell non-Hodgkin's lymphoma
(NHL) ASH
2002
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| Lymphoma in older patients. J Clin Oncol. 2007
May 10;25(14):1916-23. PMID:
17488991
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Tailoring treatment for
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Side effects: Elderly patients
with non-Hodgkin lymphoma who receive chemotherapy are at higher
risk
for osteoporosis and fractures. Leuk Lymphoma. 2007
Aug;48(8):1514-21. PMID: 17701582
Use of chemotherapy was significantly associated with increased
risk of fracture and osteoporosis in elderly patients with NHL
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| Cancer in the Elderly: Tailoring Treatment , Lodovico Balducci
PubMed
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Features of chemotherapy of malignant tumors in elderly
patients
Adv Gerontol. 2002;10:126-30. Review. Russian. PMID:
12577700 | Related abstracts
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Regimen Tailored to Elderly Patients Shows Promise Against NHL
Medscape (free login req.) 02_01_03
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| The
Influence of advanced age on the treatment and prognosis of
diffuse large-cell lymphoma (DLCL). Clin Lymphoma. 2001
Mar;1(4):278-84. Review.
PMID: 11707842 PubMed
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| The Geriatric Patient: Equal Benefit from Equal
Treatment, Lodovico Balducci, MD Medscape
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Use of growth factors in the elderly patient with cancer: a
report from the Second International Society for Geriatric
Oncology (SIOG) 2001 meeting. Crit Rev Oncol
Hematol. 2003 Feb;45(2):123-8. Review.
PMID:
12604125
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