Advances in treatment of elderly primary central nervous system lymphoma
Summary The management of older individuals (≥60 years) with primary central nervous system lymphoma remains a clinical challenge. Identification of optimal therapy and delivering adequate dose intensity are two of the major issues in treating elderly patients. Premorbid performance status and comor...
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| Veröffentlicht in: | British journal of haematology 2022-02, Vol.196 (3), p.473-487 |
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| container_title | British journal of haematology |
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| creator | Martinez‐Calle, Nicolas Isbell, Lisa K. Cwynarski, Kate Schorb, Elisabeth |
| description | Summary
The management of older individuals (≥60 years) with primary central nervous system lymphoma remains a clinical challenge. Identification of optimal therapy and delivering adequate dose intensity are two of the major issues in treating elderly patients. Premorbid performance status and comorbidities influence individualised treatment approaches and geriatric assessment tools are increasingly utilised. Optimal induction treatment remains high‐dose methotrexate‐based immunochemotherapy, delivery is feasible in the majority of patients and the goal of treatment remains achieving complete remission. Consolidation strategies are also relevant in the elderly, aiming to maximise duration of response and quality of life (QoL). Potential options include high‐dose therapy with haematopoietic stem cell consolidation, non‐myeloablative chemotherapy and whole‐brain radiotherapy. Efficacy of novel agents, such as Bruton tyrosine kinase inhibitors and lenalidomide, have been reported; these represent an alternative for elderly patients unfit for chemotherapy. Prognosis remains poor, improvement of outcomes in this age group is urgently needed. |
| doi_str_mv | 10.1111/bjh.17799 |
| format | Article |
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The management of older individuals (≥60 years) with primary central nervous system lymphoma remains a clinical challenge. Identification of optimal therapy and delivering adequate dose intensity are two of the major issues in treating elderly patients. Premorbid performance status and comorbidities influence individualised treatment approaches and geriatric assessment tools are increasingly utilised. Optimal induction treatment remains high‐dose methotrexate‐based immunochemotherapy, delivery is feasible in the majority of patients and the goal of treatment remains achieving complete remission. Consolidation strategies are also relevant in the elderly, aiming to maximise duration of response and quality of life (QoL). Potential options include high‐dose therapy with haematopoietic stem cell consolidation, non‐myeloablative chemotherapy and whole‐brain radiotherapy. Efficacy of novel agents, such as Bruton tyrosine kinase inhibitors and lenalidomide, have been reported; these represent an alternative for elderly patients unfit for chemotherapy. Prognosis remains poor, improvement of outcomes in this age group is urgently needed.</description><identifier>ISSN: 0007-1048</identifier><identifier>EISSN: 1365-2141</identifier><identifier>DOI: 10.1111/bjh.17799</identifier><identifier>PMID: 34448202</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Algorithms ; Central nervous system ; Central Nervous System Neoplasms - diagnosis ; Central Nervous System Neoplasms - etiology ; Central Nervous System Neoplasms - therapy ; Chemotherapy ; Clinical Decision-Making ; Combined Modality Therapy - methods ; Disease Management ; elderly ; Geriatric Assessment ; Hematology ; Hematopoietic stem cells ; high‐dose methotrexate ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin - diagnosis ; Lymphoma, Non-Hodgkin - etiology ; Lymphoma, Non-Hodgkin - therapy ; Methotrexate ; Neoplasm Grading ; Neoplasm Staging ; Nervous system ; Older people ; Patients ; primary central nervous system lymphoma ; Prognosis ; Protein-tyrosine kinase ; Quality of Life ; Radiation therapy ; Remission ; Retreatment ; Stem cells ; Treatment Outcome</subject><ispartof>British journal of haematology, 2022-02, Vol.196 (3), p.473-487</ispartof><rights>2021 British Society for Haematology and John Wiley & Sons Ltd</rights><rights>2021 British Society for Haematology and John Wiley & Sons Ltd.</rights><rights>2022 British Society for Haematology and John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3889-4f844ed76b1c237e8e0f4f52b608d340f55436c5ae13030431a6a6db4605e1413</citedby><cites>FETCH-LOGICAL-c3889-4f844ed76b1c237e8e0f4f52b608d340f55436c5ae13030431a6a6db4605e1413</cites><orcidid>0000-0003-0948-2125 ; 0000-0002-5184-9464</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fbjh.17799$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fbjh.17799$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34448202$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Martinez‐Calle, Nicolas</creatorcontrib><creatorcontrib>Isbell, Lisa K.</creatorcontrib><creatorcontrib>Cwynarski, Kate</creatorcontrib><creatorcontrib>Schorb, Elisabeth</creatorcontrib><title>Advances in treatment of elderly primary central nervous system lymphoma</title><title>British journal of haematology</title><addtitle>Br J Haematol</addtitle><description>Summary
The management of older individuals (≥60 years) with primary central nervous system lymphoma remains a clinical challenge. Identification of optimal therapy and delivering adequate dose intensity are two of the major issues in treating elderly patients. Premorbid performance status and comorbidities influence individualised treatment approaches and geriatric assessment tools are increasingly utilised. Optimal induction treatment remains high‐dose methotrexate‐based immunochemotherapy, delivery is feasible in the majority of patients and the goal of treatment remains achieving complete remission. Consolidation strategies are also relevant in the elderly, aiming to maximise duration of response and quality of life (QoL). Potential options include high‐dose therapy with haematopoietic stem cell consolidation, non‐myeloablative chemotherapy and whole‐brain radiotherapy. Efficacy of novel agents, such as Bruton tyrosine kinase inhibitors and lenalidomide, have been reported; these represent an alternative for elderly patients unfit for chemotherapy. Prognosis remains poor, improvement of outcomes in this age group is urgently needed.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Algorithms</subject><subject>Central nervous system</subject><subject>Central Nervous System Neoplasms - diagnosis</subject><subject>Central Nervous System Neoplasms - etiology</subject><subject>Central Nervous System Neoplasms - therapy</subject><subject>Chemotherapy</subject><subject>Clinical Decision-Making</subject><subject>Combined Modality Therapy - methods</subject><subject>Disease Management</subject><subject>elderly</subject><subject>Geriatric Assessment</subject><subject>Hematology</subject><subject>Hematopoietic stem cells</subject><subject>high‐dose methotrexate</subject><subject>Humans</subject><subject>Lymphoma</subject><subject>Lymphoma, Non-Hodgkin - diagnosis</subject><subject>Lymphoma, Non-Hodgkin - etiology</subject><subject>Lymphoma, Non-Hodgkin - therapy</subject><subject>Methotrexate</subject><subject>Neoplasm Grading</subject><subject>Neoplasm Staging</subject><subject>Nervous system</subject><subject>Older people</subject><subject>Patients</subject><subject>primary central nervous system lymphoma</subject><subject>Prognosis</subject><subject>Protein-tyrosine kinase</subject><subject>Quality of Life</subject><subject>Radiation therapy</subject><subject>Remission</subject><subject>Retreatment</subject><subject>Stem cells</subject><subject>Treatment Outcome</subject><issn>0007-1048</issn><issn>1365-2141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1Lw0AQhhdRbK0e_AOy4EUPaWc_skmPtahVCl70vGySCU3JR91NKvn3rqZ6EJzLwPDw8s5DyCWDKfMzS7abKYui-fyIjJlQYcCZZMdkDABRwEDGI3Lm3BaACQjZKRkJKWXMgY_JapHtTZ2io0VNW4umrbBuaZNTLDO0ZU93tqiM7Wnq79aUtEa7bzpHXe9arGjZV7tNU5lzcpKb0uHFYU_I28P963IVrF8en5aLdZCKOJ4HMo-lxCxSCUu5iDBGyGUe8kRBnAkJeRhKodLQoO8qQApmlFFZIhWE6L8SE3Iz5O5s896ha3VVuBTL0tToa2keKgUiUkx59PoPum06W_t2mivO5ZxHwD11O1CpbZyzmOvDx5qB_tKrvV79rdezV4fELqkw-yV_fHpgNgAfRYn9_0n67nk1RH4CksOCXg</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>Martinez‐Calle, Nicolas</creator><creator>Isbell, Lisa K.</creator><creator>Cwynarski, Kate</creator><creator>Schorb, Elisabeth</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0948-2125</orcidid><orcidid>https://orcid.org/0000-0002-5184-9464</orcidid></search><sort><creationdate>202202</creationdate><title>Advances in treatment of elderly primary central nervous system lymphoma</title><author>Martinez‐Calle, Nicolas ; Isbell, Lisa K. ; Cwynarski, Kate ; Schorb, Elisabeth</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3889-4f844ed76b1c237e8e0f4f52b608d340f55436c5ae13030431a6a6db4605e1413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Algorithms</topic><topic>Central nervous system</topic><topic>Central Nervous System Neoplasms - diagnosis</topic><topic>Central Nervous System Neoplasms - etiology</topic><topic>Central Nervous System Neoplasms - therapy</topic><topic>Chemotherapy</topic><topic>Clinical Decision-Making</topic><topic>Combined Modality Therapy - methods</topic><topic>Disease Management</topic><topic>elderly</topic><topic>Geriatric Assessment</topic><topic>Hematology</topic><topic>Hematopoietic stem cells</topic><topic>high‐dose methotrexate</topic><topic>Humans</topic><topic>Lymphoma</topic><topic>Lymphoma, Non-Hodgkin - diagnosis</topic><topic>Lymphoma, Non-Hodgkin - etiology</topic><topic>Lymphoma, Non-Hodgkin - therapy</topic><topic>Methotrexate</topic><topic>Neoplasm Grading</topic><topic>Neoplasm Staging</topic><topic>Nervous system</topic><topic>Older people</topic><topic>Patients</topic><topic>primary central nervous system lymphoma</topic><topic>Prognosis</topic><topic>Protein-tyrosine kinase</topic><topic>Quality of Life</topic><topic>Radiation therapy</topic><topic>Remission</topic><topic>Retreatment</topic><topic>Stem cells</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Martinez‐Calle, Nicolas</creatorcontrib><creatorcontrib>Isbell, Lisa K.</creatorcontrib><creatorcontrib>Cwynarski, Kate</creatorcontrib><creatorcontrib>Schorb, Elisabeth</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of haematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Martinez‐Calle, Nicolas</au><au>Isbell, Lisa K.</au><au>Cwynarski, Kate</au><au>Schorb, Elisabeth</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Advances in treatment of elderly primary central nervous system lymphoma</atitle><jtitle>British journal of haematology</jtitle><addtitle>Br J Haematol</addtitle><date>2022-02</date><risdate>2022</risdate><volume>196</volume><issue>3</issue><spage>473</spage><epage>487</epage><pages>473-487</pages><issn>0007-1048</issn><eissn>1365-2141</eissn><abstract>Summary
The management of older individuals (≥60 years) with primary central nervous system lymphoma remains a clinical challenge. Identification of optimal therapy and delivering adequate dose intensity are two of the major issues in treating elderly patients. Premorbid performance status and comorbidities influence individualised treatment approaches and geriatric assessment tools are increasingly utilised. Optimal induction treatment remains high‐dose methotrexate‐based immunochemotherapy, delivery is feasible in the majority of patients and the goal of treatment remains achieving complete remission. Consolidation strategies are also relevant in the elderly, aiming to maximise duration of response and quality of life (QoL). Potential options include high‐dose therapy with haematopoietic stem cell consolidation, non‐myeloablative chemotherapy and whole‐brain radiotherapy. Efficacy of novel agents, such as Bruton tyrosine kinase inhibitors and lenalidomide, have been reported; these represent an alternative for elderly patients unfit for chemotherapy. Prognosis remains poor, improvement of outcomes in this age group is urgently needed.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>34448202</pmid><doi>10.1111/bjh.17799</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0003-0948-2125</orcidid><orcidid>https://orcid.org/0000-0002-5184-9464</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Factors Aged Aged, 80 and over Algorithms Central nervous system Central Nervous System Neoplasms - diagnosis Central Nervous System Neoplasms - etiology Central Nervous System Neoplasms - therapy Chemotherapy Clinical Decision-Making Combined Modality Therapy - methods Disease Management elderly Geriatric Assessment Hematology Hematopoietic stem cells high‐dose methotrexate Humans Lymphoma Lymphoma, Non-Hodgkin - diagnosis Lymphoma, Non-Hodgkin - etiology Lymphoma, Non-Hodgkin - therapy Methotrexate Neoplasm Grading Neoplasm Staging Nervous system Older people Patients primary central nervous system lymphoma Prognosis Protein-tyrosine kinase Quality of Life Radiation therapy Remission Retreatment Stem cells Treatment Outcome |
| title | Advances in treatment of elderly primary central nervous system lymphoma |
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