Treatment of non-Hodgkin’s lymphomas in elderly patients
MUDr. Juraj Ďuraš1,2; MUDr. Michal Kaščák1,2; prof. MUDr. Roman Hájek, CSc.1,2
1 Klinika hematoonkologie, Fakultní nemocnice Ostrava
2 Klinika hematoonkologie, LF Ostravské univerzity, Ostrava
Recent demographic trends with increasing proportion of elderly people are associated with the higher incidence of hematological malignancies including non-Hodgkin's lymphomas. Higher age is associated with a significantly worse prognosis because of physiological decline of organ functions and increasing incidence of comorbidities that both limit treatment options.
Staging procedures in elderly patients do not differ significantly from younger patients. The standard imaging method is computed tomography (CT), positron emission tomography (PET) / CT is recommended in patients with aggressive lymphoma treated with curative intent. In follicular lymphoma, PET/CT is recommended especially before local radiotherapy to confirm localized disease.
A Geriatric 8 (G8) questionnaire is recommended as a screening tool for geriatric assessment. In the case of score ≤14, a comprehensive geriatric assessment including assessment of performance status, activities of daily life, mental status, possible sensory impairment and comorbidities is recommended.
Treatment of elderly patients with lymphoma requires personalized approach. In fit patients who are able to tolerate standard treatment, the outcomes are similar to outcomes in young patients. In vulnerable patients treatment should be conducted with the aim of prolonging life with respect to its quality while avoiding intensive treatment procedures with risk of toxicity. In terminal patients who won't profit from oncological therapy, only symptomatic supportive treatment is recommended. Treatment options for most common lymphoma subtypes are discussed in second part of the article.
non-Hodgkin lymphoma, elderly patients, treatment
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