Department of Hematology, Institut Bergonié, Inserm U1218, SIRIC BRIO, Université de Bordeaux, Bordeaux, France.
Lymphoma Unit, Department of Hematology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain.
Curr Opin Oncol. 2019 Sep;31(5):369-373. doi: 10.1097/CCO.0000000000000559.
The current review will outline recent data which may improve management of older patients with aggressive lymphoma through comanagement by hematologists and geriatricians.
Many recent data show that determinants of prognosis differ in older patients with an increased importance of nonlymphoma-related parameters. As a consequence, geriatric assessment parameters are predictive of the outcome in these patients. Data from clinical trials allow for standardization of chemotherapy in diffuse large B-cell lymphoma even in older fit patients. Yet data are missing in vulnerable and frail patients. Recent results show that anthracyclines appear essential also in vulnerable patients although precautions should be considered. Geriatric intervention will be the next step but its potential value remains to be demonstrated.
Although aggressive lymphoma therapy is well standardized, management of vulnerable and frail patients remains complicated because of the accumulation of comorbidities and geriatric syndromes and because they are excluded from clinical trials. Comanagement with hematologists and geriatricians may be the solution to improve outcome but organization of care should reinvented.
本综述将概述最近的数据，这些数据可能通过血液学家和老年病学家的共同管理来改善侵袭性淋巴瘤老年患者的治疗。
许多最近的数据表明，老年患者的预后决定因素不同，非淋巴瘤相关参数的重要性增加。因此，老年评估参数可预测这些患者的预后。临床试验的数据允许在弥漫性大 B 细胞淋巴瘤中即使在身体状况较好的老年患者中也能进行标准化化疗。然而，脆弱和虚弱患者的数据仍然缺失。最近的结果表明，蒽环类药物在脆弱患者中似乎也是必不可少的，尽管应考虑谨慎用药。老年干预将是下一步，但它的潜在价值仍有待证明。
尽管侵袭性淋巴瘤的治疗已经得到很好的标准化，但由于合并症和老年综合征的积累，以及由于他们被排除在临床试验之外，脆弱和虚弱患者的治疗仍然很复杂。血液学家和老年病学家的共同管理可能是改善预后的解决方案，但护理的组织方式需要重新设计。
