Der Onkologe

, Volume 16, Issue 1, pp 55–62 | Cite as

Therapiestrategien für die Behandlung des Hodgkin-Lymphoms bei älteren Patienten

Leitthema
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Zusammenfassung

Ältere Patienten mit einem Hodgkin-Lymphom haben besonders in fortgeschrittenen Stadien unverändert eine relativ schlechte Prognose. Evidenzbasierte Therapieempfehlungen können wegen der sehr beschränkten Studienlage nicht gegeben werden. In der täglichen Praxis bei Patienten in frühen Stadien kann die Combined-Modality-Behandlung (2–4 Zyklen einer A(B)VD-Chemotherapie (Adriamycin, Bleomycin, Vinblastin, Dacarbazin, gefolgt von einer Involved-Field-Strahlentherapie), als etabliert gelten; bei Patienten in fortgeschrittenen Stadien erfolgen 6–8 Zyklen ABVD mit Radiatio nur der Restbefunde. Aggressivere Chemotherapie ist aufgrund der Komorbiditäten in diesem Patientenkollektiv und der eingeschränkten Tolerabilität der Chemotherapie oftmals nicht durchführbar. Daher ist das Ziel der aktuellen klinischen Forschung weiterhin die Entwicklung einer Behandlung mit hoher Effektivität bei reduzierter Toxizität. Hierfür müssen vorliegende Begleiterkrankungen, innovative Therapieansätze, aber auch die Lebensqualität während und nach der Therapie bereits in die Studienplanung einbezogen werden. Die GHSG (German Hodgkin Lymphoma Study Group) hat deshalb aktuell eine Phase-I/II-Studie initiiert, in der Bleomycin im ABVD-Schema durch die immunmodulatorische Substanz Lenalidomid ersetzt wird.

Schlüsselwörter

Ältere Patienten Lymphom Hodgkin Therapie Prognose 

Therapy strategies for the treatment of Hodgkin’s lymphoma in elderly patients

Abstract

Elderly patients with Hodgkin’s lymphoma still have a relative poor prognosis especially in advanced stages. Due to the lack of large randomized studies, no evidence-based standard treatment can be defined. In routine practice patients with early stages disease are treated with a combined modality strategy of 2–4 cycles A(B)VD (adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy followed by involved-field radiation therapy. Patients with advanced stage disease are usually treated with 6–8 cycles of A(B)VD followed by radiotherapy to residual disease. A more aggressive regimen would be preferable but is frequently not feasible in this patient cohort due to comorbidities. Therefore, the aim of future studies is still to develop regimens with high anti-tumor efficacy but low toxicity. These studies require an elderly-specific design that takes comorbidities, innovative treatment approaches and quality of life issues during therapy and follow-up into account. Therefore, the GHSG (German Hodgkin Lymphoma Study Group) has initiated a phase I/II study to investigate the new immunomodulatory drug lenalidomide in combination with AVD in elderly patients with early unfavorable or advanced stage disease.

Keywords

Elderly patients Lymphoma Hodgkin Treatment Prognosis 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2010

Authors and Affiliations

  1. 1.German Hodgkin Study Group (GHSG)KölnDeutschland
  2. 2.Klinik I für Innere MedizinUniversitätsklinikum KölnKölnDeutschland

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