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Aggressive B-Zell-Lymphome bei älteren Patienten

Kurative oder palliative Behandlungsstrategie?

Aggressive B cell lymphomas in elderly patients

Curative or palliative treatment strategy?

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Aggressive Lymphome treten mit zunehmendem Lebensalter häufiger auf. Das mediane Erkrankungsalter beträgt 64 Jahre. Die Therapieentscheidung für ein kuratives oder palliatives Konzept bei Patienten über 65 Jahren ist schwierig und wird oft von Komorbiditäten und weiteren sozialen und vom Behandler abhängigen Faktoren bestimmt.

Ziel

Ergebnisse aus publizierten Studien werden in der folgenden Arbeit zusammengefasst und interpretiert und ein Vorschlag zur Therapientscheidungsfindung in diesem Patientenkollektiv vorgestellt.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in PubMed unter den Stichpunkten „aggressive Lymphoma“, „elderly“, „therapy“ sowie auf der Auswertung eigener Daten der Deutschen Studiengruppe Hochmaligne Lymphome.

Ergebnisse und Diskussion

Auch bei älteren Patienten mit aggressivem Lymphom ist eine kombinierte, anthrazyklinhaltige Immunchemotherapie (R-CHOP) der einzig kurative Therapieansatz mit einer Fünfjahresüberlebensrate bei „fitten“ alten Patienten von ca. 75 %. Ob eine solche Therapie möglich ist oder ein palliativ-lebensverlängerndes Konzept gewählt werden sollte, darf immer erst nach einer Vorphasentherapie entschieden werden. Gleichzeitig müssen Komorbiditäten und soziale Faktoren wie Einschränkungen im täglichen Leben in diesem Patientenkollektiv berücksichtigt werden. Eine Entscheidungshilfe können sog. geriatrische Assessments liefern. Die Entscheidung liegt jedoch beim behandelnden Arzt und muss individuell für und mit dem jeweiligen Patienten getroffen werden

Abstract

Background

Aggressive 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.

Aim

The results of published studies are summarized and discussed in this article. Recommendation for decision-making in this patient collective are presented.

Material and methods

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.

Results and discussion

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.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. L. Trümper ist Leiter der klinischen Prüfung der BRENDA-Studie der DSHNHL. Diese Studie wird von Roche Pharma, Grenzach, und Mundipharma, Limburg, im Rahmen einer wissenschaftlichen Kooperation mit der IfS GmbH, Göttingen, finanziell unterstützt.

Der Beitrag enthält keine Studien an Menschen oder Tieren. Reviewartikel: referierte publizierte Studien.

Author information

Authors and Affiliations

  1. Department Hämatologie und Onkologie, Kantonsspital Chur, Chur, Schweiz

    K. Hohloch

  2. Onkologisches Zentrum Traunstein, Klinikum Traunstein, Traunstein, Deutschland

    F. Zettl

  3. Klinik für Hämatologie und Medizinische Onkologie, UniversitätsKrebszentrum (G-CCC), Universitätsmedizin Göttingen, 37099, Göttingen, Deutschland

    K. Hohloch, F. Zettl &  L. Trümper

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  1. K. Hohloch
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Correspondence to L. Trümper.

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Hohloch, K., Zettl, F. & Trümper, L. Aggressive B-Zell-Lymphome bei älteren Patienten. Onkologe 21, 496–507 (2015). https://doi.org/10.1007/s00761-014-2830-z

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  • DOI: https://doi.org/10.1007/s00761-014-2830-z

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