Klepin Heidi D, Rizzieri David, Palumbo Antonio, Magarotto Valeria, Eichhorst Barbara
From the Comprehensive Cancer Center of Wake Forest University, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC; Department of Medicine, Division of Hematologic Malignancies and Cell Therapy, Duke University Medical Center, Durham, NC; Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy; Department I of Internal Medicine and Center of Integrated Oncology Köln Bonn, University of Cologne, Köln, Germany.
Am Soc Clin Oncol Educ Book. 2013:208-19. doi: 10.14694/EdBook_AM.2013.33.208.
Hematologic malignancies are a common cause of morbidity and mortality among older adults, who represent the majority of patients diagnosed with these diseases. Treatment options and disease outcomes have improved in recent years because of the development of novel treatment strategies and the design of elderly-specific clinical trials. Despite this, extrapolation of clinical trial data to patients routinely seen in practice is challenging because of the presence of multimorbidity and functional impairments. Individualized treatment decision making requires not only an understanding of underlying tumor biology but also careful estimation of an older patient's anticipated ability to withstand the stresses of therapy. This article will discuss approaches to standardizing patient assessment strategies and tailoring therapeutic decisions for older adults with hematologic malignancies with a focus on acute myeloid leukemia (AML), allogeneic bone marrow transplantation, multiple myeloma (MM), and chronic lymphocytic leukemia (CLL).
血液系统恶性肿瘤是老年人发病和死亡的常见原因，而老年人是被诊断患有这些疾病的大多数患者。由于新型治疗策略的发展和针对老年人的临床试验设计，近年来治疗选择和疾病预后有所改善。尽管如此，由于存在多种合并症和功能障碍，将临床试验数据外推至实际中常规就诊的患者仍具有挑战性。个体化治疗决策不仅需要了解潜在的肿瘤生物学特性，还需要仔细评估老年患者承受治疗压力的预期能力。本文将讨论标准化患者评估策略以及为患有血液系统恶性肿瘤的老年人量身定制治疗决策的方法，重点关注急性髓系白血病（AML）、异基因骨髓移植、多发性骨髓瘤（MM）和慢性淋巴细胞白血病（CLL）。
