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.
aDepartment of Hematology, Institut Bergonié, Inserm U1218, SIRIC BRIO, Université de Bordeaux, Bordeaux, France
bLymphoma Unit, Department of Hematology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
Correspondence to Pierre-Louis Soubeyran, Department of Hematology, Institut Bergonié, Inserm U1218, SIRIC BRIO, Université de Bordeaux, 229 cours de l’Argonne, 33076 Bordeaux Cedex, France. Tel: +33 556 333 269; fax: +33 556 33 33 30; e-mail: email@example.com