No CrossRef data available.
Article contents
Diagnosis and management of haematological malignancies in older people
Published online by Cambridge University Press: 25 May 2011
Summary
The incidence of most haematological malignancies increases with age. Given that those aged >65 years represent the fastest growing segment of Western populations, these cancers may commonly present to medical teams with an interest in older patients. Over the last 20 years there have been dramatic improvements in the outlook for patients diagnosed with haematological cancers, but there is evidence that many of these improvements have been restricted to younger patients. It is therefore important that older patients with haematological malignancies are rapidly diagnosed and promptly treated with the best available therapies. Clinical trials that specifically encompass older patients are clearly important. In this review, the presentation and management of common haematological malignancies will be discussed, including myelodysplasia, acute leukaemia, lymphoproliferative disorders and myeloma.
- Type
- Clinical geriatrics
- Information
- Copyright
- Copyright © Cambridge University Press 2011
References
1Jarrett, RF, Stark, GL, White, J, Angus, B, Alexander, FE, Krajewski, AS, Freeland, J, Taylor, GM, Taylor, PR; Scotland and Newcastle Epidemiology of Hodgkin Disease Study Group. Impact of tumour Epstein-Barr virus status on presenting features and outcome in age-defined subgroups of patients with classical Hodgkin lymphoma: a population-based study. Blood 2005; 106: 2444–51.CrossRefGoogle ScholarPubMed
2Appelbaum, FR, Gundacker, H, Head, DR, Slovak, ML, Willman, CL, Godwin, JE, Anderson, JE, Petersdorf, SH. Age and acute myeloid leukaemia. Blood 2006; 107: 3481–85.CrossRefGoogle Scholar
3Kennedy, BJ, Loeb, V, Peterson, VM, Donegan, WL, Natarajan, N, Mettlin, C. National survey of patterns of care for Hodgkin's disease. Cancer 1985; 56: 2547–56.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
4Clarke, CA, Glaser, SL, Dorfman, RF, Mann, R, DiGiuseppe, JA, Prehn, AW, Ambinder, RF. Epstein-Barr virus and survival after Hodgkin disease in a population-based series of women. Cancer 2001; 91: 1579–87.3.0.CO;2-L>CrossRefGoogle Scholar
5Stark, GL, Wood, KM, Jack, F, Angus, B, Proctor, SJ, Taylor, PR. Hodgkin's disease in the elderly: a population-based study. Br J Haematol 2004; 119: 432–40.CrossRefGoogle Scholar
6van der Holt, B, Breems, DA, Berna Beverloo, H, van den Berg, E, Burnett, AK, Sonneveld, P, Löwenberg, B. Various distinctive cytogenetic abnormalities in patients with acute myeloid leukaemia aged 60 years and older express adverse prognostic value. Results from a prospective clinical trial. Br J Haematol 2007; 136: 96–105.CrossRefGoogle ScholarPubMed
7Leith, CP, Kopecky, KJ, Godwin, J, McConnell, T, Slovak, ML, Chen, IM, Head, DR, Appelbaum, FR, Willman, CL. Acute myeloid leukaemia in the elderly: assessment of multidrug resistance (MDR1) and cytogenetics distinguishes biological subgroups with remarkably distinct responses to standard chemotherapy. A southwest oncology group study. Blood 1997; 89: 3323–29.CrossRefGoogle ScholarPubMed
8Aapro, MS, Cameron, DA, Pettengell, R, Bohlius, J, Crawford, J, Ellis, M, Kearney, N, Lyman, GH, Tjan-Heijnen, VC, Walewski, J, Weber, DC, Zielinski, C; European Organisation for Research and Treatment of Cancer (EORTC). Granulocyte Colony-Stimulating Factor (G-CSF) Guidelines Working Party. EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 2006; 42: 2433–53.CrossRefGoogle ScholarPubMed
9Proctor, SJ, Wilkinson, J. A web-based study concept designed to progress clinical research for ‘orphan’ disease area in haematological oncology in the elderly: the SHIELD programme. Crit Rev Oncol Haematol 2007; 61: 79–83.CrossRefGoogle Scholar
10Juliusson, G, Antunovic, P, Derolf, A, Lehmann, S, Möllgård, L, Stockelberg, D, Tidefelt, U, Wahlin, A, Höglund, M. Age and acute myeloid leukaemia: real world data on decision to treat and outcomes from the Swedish Acute Leukaemia Registry. Blood 2009; 113: 4179–87.CrossRefGoogle Scholar
11Arber, DA, Brunning, RD, LeBeau, MM et al. Acute myeloid leukaemia and related precursors neoplasms. In Swerdlo, H, Campo, E, Harris, NL et al. (eds), WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (4th edn). Lyon: International Agency for Research on Cancer, 2008; pp. 110–147.Google Scholar
12Burnett, AK, Milligan, D, Goldstone, A, Prentice, A, McMullin, MF, Dennis, M, Sellwood, E, Pallis, M, Russell, N, Hills, RK, Wheatley, K; United Kingdom National Cancer Research Institute Haematological Oncology Study Group. The impact of dose escalation and resistance modulation in older patients with acute myeloid leukaemia and high risk myelodysplastic syndrome: the results of the LRF AML14 trial. Br J Haematol 2009; 145: 318–32.CrossRefGoogle ScholarPubMed
13Klepin, HD, Balducci, L. Acute myelogenous leukaemia in older adults. Oncologist 2009; 14: 222–32.CrossRefGoogle ScholarPubMed
14Ciurea, SO, Rodrigues, M, Geralt, S, de Lima, M. Aging, acute myelogenous leukaemia and allogeneic transplantation: do they belong in the same sentence? Clin Lymphoma Myeloma 2009; 9: 289–97.CrossRefGoogle ScholarPubMed
15Williamson, PJ, Kruger, AR, Reynolds, PJ, Hamblin, TJ, Oscier, DG. Establishing the incidence of myelodysplastic syndromes. Br J Haematol 1994; 87: 743–45.CrossRefGoogle Scholar
16Greenberg, P, Cox, C, LeBeau, MM, Fenaux, P, Morel, P, Sanz, G, Sanz, M, Vallespi, T, Hamblin, T, Oscier, D, Ohyashiki, K, Toyama, K, Aul, C, Mufti, G, Bennett, J. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 1997; 89: 2079–88.CrossRefGoogle ScholarPubMed
17Tefferi, A, Stone, RM. Iron chelation therapy in myelodysplastic syndrome – Cui bono? Leukemia 2009; 23: 1373.CrossRefGoogle ScholarPubMed
18Sekeres, MA, List, AF. Active treatment strategies improving outcomes in patients with myelodysplastic syndromes with the deletion 5q abnormality. Clin Leukaemia 2008; 2: 28–33.CrossRefGoogle Scholar
19List, A, Kurtin, S, Roe, DJ, Buresh, A, Mahadevan, D, Fuchs, D, Rimsza, L, Heaton, R, Knight, R, Zeldis, JB. Efficacy of lenalidomide in myelodysplastic synromes. N Engl J Med 2005; 352: 549–57.CrossRefGoogle Scholar
20Seymour, JF, Fenaux, P, Silverman, LR, Mufti, GJ, Hellström-Lindberg, E, Santini, V, List, AF, Gore, SD, Backstrom, J, McKenzie, D, Beach, CL. Effects of azacitadine compared with conventional care regimens in the elderly (>=75 years) patients with higher-risk myelodysplastic syndromes. Crit Rev Oncol Hematol 2010; 76: 218–27.CrossRefGoogle Scholar
21Kantarjian, HM. Treatment of myelodysplastic syndrome: questions raised by the azacitidine experience. J Clin Oncol 2002; 20: 2415–16.CrossRefGoogle ScholarPubMed
22Wijermans, P, Suciu, S, Baila, L et al. Low dose decitabine versus best supportive care in elderly patients with intermediate or high risk MDS not eligible for intensive chemotherapy: Final results of the randomized phase III study (06011) of the EORTC Leukaemia and German MDS Study Groups. Abstract. Blood 2008; 112: 226a.CrossRefGoogle Scholar
23Roy, P, Vaughan Hudson, G, Vaughan Hudson, B et al. A comparison of relative survival in patients in trials and those recorded in population-based cancer registries. Eur J Cancer 2000; 36: 384–89.CrossRefGoogle ScholarPubMed
24Levis, A, Anselmo, AP, Ambrosetti, A, Adamo, F, Bertini, M, Cavalieri, E, Gavarotti, P, Genua, A, Liberati, M, Pavone, V, Pietrasanta, D, Ricetti, MM, Scalabrini, DR, Salvi, F, Vitolo, U, Angelucci, E, Boccadoro, M, Gallo, E, Mandelli, F; Intergruppo Italiano Linfomi (IIL). VEPEMB in elderly Hodgkin's lymphoma patients. Results from an Intergruppo Italiano Linfomi (IIL) study. Ann Oncol 2004; 15: 123–28.CrossRefGoogle ScholarPubMed
25Hasenclever, D, Diehl, V. A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's disease. N Engl J Med 1998; 339: 1506–14.CrossRefGoogle ScholarPubMed
26Erdkamp, FL, Breed, WP, Bosch, LJ, Wijnen, JT, Blijham, GB. Hodgkin's disease in the elderly, a registry-based analysis. Cancer 1992; 70: 830–34.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
27Engert, A, Ballova, V, Haverkamp, H, Pfistner, B, Josting, A, Dühmke, E, Müller-Hermelink, K, Diehl, V; German Hodgkin's Study Group. Hodgkin's lymphoma in elderly patients: A comprehensive retrospective analysis from the German Hodgkin's Study Group. J Clin Oncol 2005; 23: 5052–60.CrossRefGoogle ScholarPubMed
28Ballova, V, Rüffer, JU, Haverkamp, H, Pfistner, B, Müller-Hermelink, HK, Dühmke, E, Worst, P, Wilhelmy, M, Naumann, R, Hentrich, M, Eich, HT, Josting, A, Löffler, M, Diehl, V, Engert, A. A prospectively randomized trial carried out by the German Hodgkin Study Group for elderly patients with advanced Hodgkin's disease comparing BEACOPP baseline and COPP-ABVD (study HD9 elderly) Ann Oncol 2005; 16: 124–31.CrossRefGoogle Scholar
29The Non Hodgkin's Lymphoma Classification Project. Effect of age on the characteristics and behaviour of non-Hodgkin's lymphoma patients. Ann Oncol 1997; 8: 973–78.CrossRefGoogle Scholar
30The International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med 1993; 329: 987–94.CrossRefGoogle Scholar
31Coiffier, B, Lepage, E, Briere, J, Herbrecht, R, Tilly, H, Bouabdallah, R, Morel, P, Van Den Neste, E, Salles, G, Gaulard, P, Reyes, F, Lederlin, P, Gisselbrecht, C. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large B cell lymphoma. N Engl J Med 2002; 346: 235–42.CrossRefGoogle ScholarPubMed
32Pfreundschuh, M, Schubert, J, Ziepert, M. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol 2008; 9: 105–16.CrossRefGoogle ScholarPubMed
33Pfreundschuh, M. How I treat elderly patients with diffuse large B cell lymphoma. Blood 2010; 116: 5103–10.CrossRefGoogle Scholar
34Hershman, DL, McBride, RB, Eisenberger, A, Tsai, WY, Grann, R, Jacobson, JS. Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse large B cell lymphoma. J Clin Oncol 2008; 26: 3159–65.CrossRefGoogle Scholar
35Smith, TJ, Khatcheressian, J, Lyman, GH, Ozer, H, Armitage, JO, Balducci, L, Bennett, CL, Cantor, SB, Crawford, J, Cross, SJ, Demetri, G, Desch, CE, Pizzo, PA, Schiffer, CA, Schwartzberg, L, Somerfield, MR, Somlo, G, Wade, JC, Wade, JL, Winn, RJ, Wozniak, AJ, Wolff, AC. 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 2006; 24: 3187–205.CrossRefGoogle ScholarPubMed
37Solal-Céligny, P, Roy, P, Colombat, P, White, J, Armitage, JO, Arranz-Saez, R, Au, WY, Bellei, M, Brice, P, Caballero, D, Coiffier, B, Conde-Garcia, E, Doyen, C, Federico, M, Fisher, RI, Garcia-Conde, JF, Guglielmi, C, Hagenbeek, A, Haïoun, C, LeBlanc, M, Lister, AT, Lopez-Guillermo, A, McLaughlin, P, Milpied, N, Morel, P, Mounier, N, Proctor, SJ, Rohatiner, A, Smith, P, Soubeyran, P, Tilly, H, Vitolo, U, Zinzani, PL, Zucca, E, Montserrat, E. Follicular Lymphoma International Prognostic Index. Blood 2004; 104: 1258–65.CrossRefGoogle ScholarPubMed
38Pulte, D, Gondos, A, Brenner, H. Ongoing improvement in outcomes for patients diagnosed as having non-Hodgkin lymphoma from the 1990s to the early 21st century. Arch Int Med 2008; 168: 469–76.CrossRefGoogle Scholar
39Marcus, R, Imrie, K, Belch, A, Cunningham, D, Flores, E, Catalano, J, Solal-Celigny, P, Offner, F, Walewski, J, Raposo, J, Jack, A, Smith, P. CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood 2005; 105: 1417–23.CrossRefGoogle ScholarPubMed
40Salles, G, Seymour, JF, Offner, F, López-Guillermo, A, Belada, D, Xerri, L, Feugier, P, Bouabdallah, R, Catalano, JV, Brice, P, Caballero, D, Haioun, C, Pedersen, LM, Delmer, A, Simpson, D, Leppa, S, Soubeyran, P, Hagenbeek, A, Casasnovas, O, Intragumtornchai, T, Fermé, C, da Silva, MG, Sebban, C, Lister, A, Estell, JA, Milone, G, Sonet, A, Mendila, M, Coiffier, B, Tilly, H. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3 randomised controlled trial. Lancet 2010; 377: 42–51.CrossRefGoogle Scholar
41Hernandez, JA, Land, KJ, McKenna, RW. Leukaemia myeloma and other lymphoreticular neoplasms. Cancer 1995; 75: 381–94.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
42Mauro, FR, Foa, R, Cerretti, R, Giannarelli, D, Coluzzi, S, Mandelli, F, Girelli, G. Autoimmune haemolytic anaemia in chronic lymphocytic leukaemia: clinical, therapeutic, and prognostic features. Blood 2000; 95: 2786–92.CrossRefGoogle ScholarPubMed
43Diehl, LF, Ketchum, LH. Autoimmune disease and chronic lymphocytic leukaemia: autoimmune haemolytic anaemia, pure red cell aplasia, and autoimmune thrombocytopenia. Semin Oncol 1998; 25: 80–97.Google ScholarPubMed
44Molica, S, Alberti, A. Prognostic value of lymphocyte doubling time in chronic lymphocytic leukaemia. Cancer 1987; 60: 2712–16.3.0.CO;2-1>CrossRefGoogle Scholar
45Tsimberidou, AM, Keating, MJ. Richter syndrome: biology, incidence and therapeutic strategies. Cancer 2005; 103: 216–28.CrossRefGoogle ScholarPubMed
46French Co-operative Group on Chronic Lymphocytic Leukemia. Effects of chlorambucil and therapeutic decisions in initial forms of chronic lymphocytic leukaemia (stage A): results of randomised clinical trials on 612 patients. Blood 1990; 75: 1414–21.CrossRefGoogle Scholar
47Paneesha, S, Milligan, DW. Stem cell transplantation for chronic lymphocytic leukaemia. Br J Haematol 2005; 128: 145–52.CrossRefGoogle ScholarPubMed
48Rawstron, AC, Bennett, FL, O'Connor, SJ, Kwok, M, Fenton, JA, Plummer, M, de Tute, R, Owen, RG, Richards, SJ, Jack, AS, Hillmen, P. Monoclonal B-cell lymphocytosis and chronic lymphocytic leukaemia. N Engl J Med 2008; 359: 575–83.CrossRefGoogle Scholar
49Kyle, RA, Therneau, TM, Rajkumar, SV, Larson, DR, Plevak, MF, Offord, JR, Dispenzieri, A, Katzmann, JA, Melton, LJ 3rd. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med 2006; 354: 362–69.CrossRefGoogle ScholarPubMed
50British Committee for Standards in Haematology in conjunction with the UK Myeloma Forum (UKMF). Guidelines on the diagnosis and management of multiple myeloma 2010. Available at: http://www.bcshguidelines.com/documents/MYELOMA_Mngmt_GUIDELINE_REVISION_Sept_2010.pdf (accessed 17 February 2011).Google Scholar
51Palumbo, A, Bringhen, S, Caravita, T, Merla, E, Capparella, V, Callea, V, Cangialosi, C, Grasso, M, Rossini, F, Galli, M, Catalano, L, Zamagni, E, Petrucci, MT, De Stefano, V, Ceccarelli, M, Ambrosini, MT, Avonto, I, Falco, P, Ciccone, G, Liberati, AM, Musto, P, Boccadoro, M; Italian Multiple Myeloma Network, GIMEMA. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet 2006; 367: 825–31.CrossRefGoogle ScholarPubMed
52San Miguel, JF, Schlag, R, Khuageva, NK, Dimopoulos, MA, Shpilberg, O, Kropff, M, Spicka, I, Petrucci, MT, Palumbo, A, Samoilova, OS, Dmoszynska, A, Abdulkadyrov, KM, Schots, R, Jiang, B, Mateos, MV, Anderson, KC, Esseltine, DL, Liu, K, Cakana, A, van de Velde, H, Richardson, PG; VISTA Trial Investigators. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 2008; 359: 906–17.CrossRefGoogle ScholarPubMed
53Palumbo, A, Falco, P, Falcone, A, Benevolo, G, Canepa, L, Gay, F, Larocca, A, Magarotto, V, Gozzetti, A, Luraschi, A, Morabito, F, Nozza, A, Knight, RD, Zeldis, JB, Boccadoro, M, Petrucci, MT. Melphalan, prednisone, and lenalidomide for newly diagnosed myeloma: kinetics of neutropenia and thrombocytopenia and time-to-event results. Clin Lymphoma Myeloma 2009; 9: 145–50.CrossRefGoogle ScholarPubMed