1,780 research outputs found
Aggressive B cell lymphomas in elderly patients. Curative or palliative treatment strategy?
No full textAggressive lymphomas are more frequent in elderly patients and the median age at diagnosis is 64 years. Rational treatment decisions for elderly patients are difficult to make and often influenced by other factors, such as comorbidities and social status as well as experience and preferences of treating physicians. The results of published studies are summarized and discussed in this article. Recommendation for decision-making in this patient collective are presented. This article is based on a PubMed search using the terms aggressive lymphoma, elderly and therapy and on the evaluation of data from the German high-grade non-Hodgkin lymphoma study group. Even in elderly patients with aggressive lymphomas a combined immunochemotherapy including anthracyclines is the only curative treatment approach with a 5-year overall survival of approximately 75 % in fit elderly patients. The decision on whether such a regimen is feasible or a palliative life-extending concept should be selected, can only be made after a prephase therapy for individual patients. In addition, comorbidities and social factors, such as limitations in daily life activities must be incorporated into the treatment plan in this patient population. Geriatric assessments may aid the establishment of rational approaches. The final decision has to be made by the treating physician in close interaction with the patient and relatives
Harnessing the Energy: Development of Radioimmunotherapy for Patients with Non-Hodgkin’s Lymphoma
No full textRadioimmunotherapy (RIT) combines the use of targeted monoclonal antibodies with radionuclides for the treatment of non-Hodgkin's lymphoma (NHL), taking advantage of its inherent radiosensitivity. A number of trials have shown significantly higher response rates and longer progression-free survival times in patients treated with the CD20-targeted radioimmunoconjugate yttrium-90-ibritumomab tiuxetan compared with the standard of care. Furthermore, these benefits have also been shown in heavily pretreated patients who relapsed or were resistant to rituximab. Currently, a number of different treatment regimens and strategies are available for the treatment of NHL patients. Therefore, in an attempt to minimize toxicity, maximize efficacy, and improve survival, it is crucial to appropriately select patients who are good candidates for individual treatment approaches. A strategy for patient selection has been developed, including the use of existing patient assessment tools, such as the Follicular Lymphoma International Prognostic Index, to determine the optimal regimen for patients with follicular lymphoma according to their disease characteristics and physical condition. Patients who are fit make ideal candidates for potentially curative regimens, which include induction chemotherapy with or without immunotherapy followed by RIT consolidation and, potentially, maintenance therapy. Patients who are considered "compromised" would also benefit from induction treatment and RIT consolidation, with a view to reducing the lymphoma burden and decreasing the risk for disease progression. "Frail" patients would be better suited to supportive therapy to control symptoms. This paper explores factors that should be considered when assessing whether a patient is a good candidate for treatment with RIT, and aids physicians in the selection of the most appropriate therapy for each patient group. The Oncologist 2009; 14(suppl 2): 4-1
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