Current Treatment Options for Older Patients with Hodgkin Lymphoma.
Opinion Statement: Older adults with Hodgkin lymphoma (HL), commonly defined as age ≥ 60 years, represent approximately 20% of the total HL population. Historically, they have significantly inferior outcomes compared with younger patients. The cause of this is multifactorial, including biologic diff...
| Publicado en: | Current Treatment Options in Oncology Vol. 21; no. 5; pp. 1 - 19 |
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| Autores principales: | , , , |
| Formato: | review Journal Article |
| Publicado: |
Springer Nature
May2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143660022&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 143660022 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15272729 3KHC jtl: Current Treatment Options in Oncology issn: 15272729 maglogo: N pubinfo: dt: May2020 vid: 21 iid: 5 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 143660022 143660022 NLM32328822 143660022 10.1007/s11864-020-00745-9 NLM32328822 143660022 ppf: 1 ppct: 18 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Current Treatment Options for Older Patients with Hodgkin Lymphoma. aug: au: Carter, Jordan David, Kevin A. Kritharis, Athena Evens, Andrew M. affil: Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, 08903, New Brunswick, NJ, USA sug: subj: Hodgkin's Disease Therapy Aged, 80 and Over Neoplasm Staging Hodgkin's Disease Mortality Hodgkin's Disease Diagnosis Treatment Outcomes Hodgkin's Disease Etiology Age Factors Aged Disease Management Geriatric Assessment Algorithms Combined Modality Therapy Clinical Assessment Tools Aged, 80 & over Aged: 65+ years ab: Opinion Statement: Older adults with Hodgkin lymphoma (HL), commonly defined as age ≥ 60 years, represent approximately 20% of the total HL population. Historically, they have significantly inferior outcomes compared with younger patients. The cause of this is multifactorial, including biologic differences (e.g., mixed cellularity and EBV-related disease); high incidence of advanced stage disease; and frequency of comorbidities and decreased organ reserve leading to poorer tolerability of therapy with increased toxicity, including treatment-related mortality. Pretreatment evaluation for older HL patients should entail a geriatric assessment (GA), with evaluation of functional status and comorbidities (e.g., geriatric cumulative illness rating scale, CIRS-G) to determine fitness. Furthermore, treatment selection should be based in part on GA, with fit older patients receiving curative chemotherapy-based regimens and unfit or frail patients considering less intensive or non-chemotherapy-based platforms. Additionally, there may be consideration for pre-phase of therapy (e.g., pulse steroids) in order to improve performance status. The inclusion of anthracycline therapy appears important, while bleomycin-containing regimens (e.g., ABVD) may be associated with prohibitive pulmonary toxicity, and intensive therapies such as BEACOPP are too toxic. benefit ratio/benefit ratio, a priori omission of bleomycin may also be considered (i.e., AVD), especially for patients older than 70 years of age. In addition, newer regimens for older HL patients integrating novel therapeutic agents into frontline treatment have emerged as effective and tolerable options. Data incorporating brentuximab vedotin sequentially before and after AVD chemotherapy represent the best-reported outcomes in older HL patients to date. In the relapsed/refractory setting, salvage chemotherapy regimens followed by autologous stem cell transplantation should be considered for fit patients, while less intensive treatment, including the use of novel targeted agents, is an option for unfit or frail patients. In this review, we examine the epidemiology, importance of GA, and current treatment options for older HL patients. pubtype: Academic Journal doctype: review Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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