Current Treatment Options for Aggressive Non-Hodgkin Lymphoma in Elderly and Frail Patients: Practical Considerations for the Hematologist

Overview

Journal Ther Adv Hematol

Specialty Hematology

Date 2021 Mar 22

PMID 33747422

Citations 6

Authors

Katrin Schmittlutz

Reinhard Marks

Affiliations

Soon will be listed here.

Abstract

Treatment decisions for aggressive non-Hodgkin lymphoma in elderly and frail patients still remain challenging. The heterogeneity of elderly patients consists of various physical and psychological states, coexisting comorbidities as well as frailty and socioeconomic status. Comprehensive geriatric assessment in elderly patients is efficient and necessary for risk stratification to identify fit patients without cardiac comorbidities who can tolerate curative treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) and those who are not suitable for a standard regimen. If anthracycline-containing therapy is not feasible, alternative treatment options have to be carefully evaluated and individual risk factors have to be considered.

Citing Articles

USP37 promotes diffuse large B-cell lymphoma progression by deubiquitinating and stabilizing c-myc.

Li Y, Wang W, Sun L, Huang J, Ma X, Li S J Mol Histol. 2024; 56(1):54.

PMID: 39722070 DOI: 10.1007/s10735-024-10323-0.

NEAT1 and CHROMR lncRNAs: a promising diagnostic tool for diffuse large B-cell lymphoma especially in elderly patients.

Rajabi A, Saber A, Kluiver J, van den Berg A, Hosseinpourfeizi M, Safaralizadeh R Biomark Med. 2024; 18(15-16):685-693.

PMID: 39263799 PMC: 11404575. DOI: 10.1080/17520363.2024.2389036.

Applied Cardio-Oncology in Hematological Malignancies: A Narrative Review.

Mandala E, Lafara K, Kokkinovasilis D, Kalafatis I, Koukoulitsa V, Katodritou E Life (Basel). 2024; 14(4).

PMID: 38672794 PMC: 11050930. DOI: 10.3390/life14040524.

Successful Treatment of Malignant Lymphoma Following Transcatheter Aortic Valve Replacement.

Osawa T, Tajiri K, Hoshi T, Ieda M, Ishizu T Intern Med. 2024; 63(17):2433-2437.

PMID: 38296474 PMC: 11442919. DOI: 10.2169/internalmedicine.3065-23.

The epidemiological patterns of non-Hodgkin lymphoma: global estimates of disease burden, risk factors, and temporal trends.

Chu Y, Liu Y, Fang X, Jiang Y, Ding M, Ge X Front Oncol. 2023; 13:1059914.

PMID: 37333805 PMC: 10272809. DOI: 10.3389/fonc.2023.1059914.

References

Moccia A, Hitz F, Hoskins P, Klasa R, Power M, Savage K . Gemcitabine, dexamethasone, and cisplatin (GDP) is an effective and well-tolerated salvage therapy for relapsed/refractory diffuse large B-cell lymphoma and Hodgkin lymphoma. Leuk Lymphoma. 2016; 58(2):324-332. DOI: 10.1080/10428194.2016.1193852. View

Wang M, Fowler N, Wagner-Bartak N, Feng L, Romaguera J, Neelapu S . Oral lenalidomide with rituximab in relapsed or refractory diffuse large cell, follicular and transformed lymphoma: a phase II clinical trial. Leukemia. 2013; 27(9):1902-9. DOI: 10.1038/leu.2013.95. View

Soubeyran P, Bellera C, Goyard J, Heitz D, Cure H, Rousselot H . Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS One. 2014; 9(12):e115060. PMC: 4263738. DOI: 10.1371/journal.pone.0115060. View

Extermann M, Overcash J, Lyman G, Parr J, Balducci L . Comorbidity and functional status are independent in older cancer patients. J Clin Oncol. 1998; 16(4):1582-7. DOI: 10.1200/JCO.1998.16.4.1582. View

Schmitz N, Zeynalova S, Nickelsen M, Kansara R, Villa D, Sehn L . CNS International Prognostic Index: A Risk Model for CNS Relapse in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP. J Clin Oncol. 2016; 34(26):3150-6. DOI: 10.1200/JCO.2015.65.6520. View

Rigacci L, Fabbri A, Puccini B, Chitarrelli I, Chiappella A, Vitolo U . Oxaliplatin-based chemotherapy (dexamethasone, high-dose cytarabine, and oxaliplatin)±rituximab is an effective salvage regimen in patients with relapsed or refractory lymphoma. Cancer. 2010; 116(19):4573-9. DOI: 10.1002/cncr.25216. View

Handforth C, Clegg A, Young C, Simpkins S, Seymour M, Selby P . The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2014; 26(6):1091-1101. DOI: 10.1093/annonc/mdu540. View

Oki Y, Noorani M, Lin P, Davis R, Neelapu S, Ma L . Double hit lymphoma: the MD Anderson Cancer Center clinical experience. Br J Haematol. 2014; 166(6):891-901. DOI: 10.1111/bjh.12982. View

Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R . CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002; 346(4):235-42. DOI: 10.1056/NEJMoa011795. View

10.

Merli F, Cavallo F, Salvi F, Tucci A, Musuraca G, Nassi L . Obinutuzumab and miniCHOP for unfit patients with diffuse large B-cell lymphoma. A phase II study by Fondazione Italiana Linfomi. J Geriatr Oncol. 2019; 11(1):37-40. DOI: 10.1016/j.jgo.2019.06.020. View

11.

Weidmann E, Neumann A, Fauth F, Atmaca A, Al-Batran S, Pauligk C . Phase II study of bendamustine in combination with rituximab as first-line treatment in patients 80 years or older with aggressive B-cell lymphomas. Ann Oncol. 2011; 22(8):1839-44. DOI: 10.1093/annonc/mdq671. View

12.

Rashidi A, Oak E, Carson K, Wagner-Johnston N, Kreisel F, Bartlett N . Outcomes with R-CEOP for R-CHOP-ineligible patients with diffuse large B-cell lymphoma are highly dependent on cell of origin defined by Hans criteria. Leuk Lymphoma. 2015; 57(5):1191-3. DOI: 10.3109/10428194.2015.1096356. View

13.

Menon M, Pittaluga S, Jaffe E . The histological and biological spectrum of diffuse large B-cell lymphoma in the World Health Organization classification. Cancer J. 2012; 18(5):411-20. PMC: 3458515. DOI: 10.1097/PPO.0b013e31826aee97. View

14.

Hutchins L, Unger J, Crowley J, COLTMAN Jr C, Albain K . Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999; 341(27):2061-7. DOI: 10.1056/NEJM199912303412706. View

15.

Park S, Grover N, Olajide O, Asch A, Wall J, Richards K . A phase II trial of bendamustine in combination with rituximab in older patients with previously untreated diffuse large B-cell lymphoma. Br J Haematol. 2016; 175(2):281-289. PMC: 5063684. DOI: 10.1111/bjh.14232. View

16.

Luminari S, Viel E, Maria Ferreri A, Zaja F, Chimienti E, Musuraca G . Nonpegylated liposomal doxorubicin combination regimen in patients with diffuse large B-cell lymphoma and cardiac comorbidity. Results of the HEART01 phase II trial conducted by the Fondazione Italiana Linfomi. Hematol Oncol. 2017; 36(1):68-75. DOI: 10.1002/hon.2425. View

17.

Oki Y, Ewer M, Lenihan D, Fisch M, Hagemeister F, Fanale M . Pegylated liposomal doxorubicin replacing conventional doxorubicin in standard R-CHOP chemotherapy for elderly patients with diffuse large B-cell lymphoma: an open label, single arm, phase II trial. Clin Lymphoma Myeloma Leuk. 2014; 15(3):152-8. PMC: 4344896. DOI: 10.1016/j.clml.2014.09.001. View

18.

Peyrade F, Jardin F, Thieblemont C, Thyss A, Emile J, Castaigne S . Attenuated immunochemotherapy regimen (R-miniCHOP) in elderly patients older than 80 years with diffuse large B-cell lymphoma: a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2011; 12(5):460-8. DOI: 10.1016/S1470-2045(11)70069-9. View

19.

Mayer L, Bally M, Cullis P, Wilson S, Emerman J . Comparison of free and liposome encapsulated doxorubicin tumor drug uptake and antitumor efficacy in the SC115 murine mammary tumor. Cancer Lett. 1990; 53(2-3):183-90. DOI: 10.1016/0304-3835(90)90212-g. View

20.

Feugier P, Van Hoof A, Sebban C, Solal-Celigny P, Bouabdallah R, Ferme C . Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol. 2005; 23(18):4117-26. DOI: 10.1200/JCO.2005.09.131. View