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Cancers
Special Issues
Recent Research of Geriatric Hematology
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Recent Research of Geriatric Hematology

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 10522

Special Issue Editors

Dr. Alessandra Tucci

E-Mail Website
Guest Editor
Department of Hematology, ASST Spedali Civili, Brescia, Italy
Interests: lymphoma; older oncohematological patients and CGA
Special Issues, Collections and Topics in MDPI journals
Dr. Annalisa Arcari

E-Mail Website
Guest Editor
Hematology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
Interests: lymphoma; chronic lymphocytic leukemia; elderly patients
Dr. Michele Spina

E-Mail Website
Guest Editor
Division of Medical Oncology and Immune-Related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
Interests: cancers in elderly patients; CGA

Special Issue Information

Dear Colleagues,

We are pleased to announce the Special Issue of Cancers focused on “Geriatric Hematology”.

The recent expansion of new treatments in the oncohematological field, in particular immune and cellular therapies, has highlighted the need to define new therapeutic pathways and to identify patients eligible for these new programs, according to their own status and to the disease presentation. On the other hand, the progressive increase in life expectancy and the improvement of socio-economic conditions has extended the age of patients suitable for treatments with curative purposes, even if the reduced functional reserve frequently observed in very old people should always be considered.

Careful stratification of patients according to their fitness is an important issue of geriatric oncology and hematology in order to define the best tailored treatment for each patient, thus avoiding under- or over-treatment.

We are pleased to invite you to contribute to this Special Issue of Cancers, which aims to focus attention on approaches to older people with indolent or aggressive oncohematological diseases and to evaluate the effectiveness of the use of Comprehensive Geriatric Assessment (CGA), both in clinical trials and in daily clinical practice.

In this Special Issue, original research articles and reviews are welcome. Research areas may primarily include lymphoma, myeloma or acute and chronic myeloid diseases, but studies addressing the application of CGA in any other hematological disease will be considered.

We look forward to receiving your contributions

Dr. Alessandra Tucci
Dr. Annalisa Arcari
Dr. Michele Spina
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • older patients
  • geriatric assessment
  • lymphoma
  • myeloma
  • acute leukemia
  • chronic lymphocytic leukemia
  • myelodysplastic syndrome
  • chronic myeloproliferative neoplasms
  • quality-of-life
  • frailty

Published Papers (7 papers)

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Research

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11 pages, 548 KiB  
Article
Adapting the Fitness Criteria for Non-Intensive Treatments in Older Patients with Acute Myeloid Leukemia to the Use of Venetoclax-Hypomethylating Agents Combination—Practical Considerations from the Real-Life Experience of the Hematologists of the Rete Ematologica Lombarda
by Giuseppe Rossi, Erika Borlenghi, Patrizia Zappasodi, Federico Lussana, Massimo Bernardi, Claudia Basilico, Alfredo Molteni, Ivana Lotesoriere, Mauro Turrini, Marco Frigeni, Monica Fumagalli, Paola Cozzi, Federica Gigli, Chiara Cattaneo, Nicola Stefano Fracchiolla, Marta Riva, Gianluca Martini, Valentina Mancini, Roberto Cairoli and Elisabetta Todisco
Cancers 2024, 16(2), 386; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers16020386 - 16 Jan 2024
Viewed by 806
Abstract
A retrospective survey was conducted in hematologic centres of the Rete Ematologica Lombarda (REL) on 529 older AML patients seen between 2020–2022. Compared to 2008–2016, the use of intensive chemotherapy (ICT) decreased from 40% to 18.1% and of hypomethylating agents (HMAs) from 19.5% [...] Read more.
A retrospective survey was conducted in hematologic centres of the Rete Ematologica Lombarda (REL) on 529 older AML patients seen between 2020–2022. Compared to 2008–2016, the use of intensive chemotherapy (ICT) decreased from 40% to 18.1% and of hypomethylating agents (HMAs) from 19.5% to 13%, whereas the combination of Venetoclax/HMA, initially not available, increased from 0% to 36.7%. Objective treatment-specific fitness criteria proposed by SIE/SIES/GITMO in 2013 allow an appropriate choice between ICT and HMAs by balancing their efficacy and toxicity. Venetoclax/HMA, registered for patients unfit to ICT, has a unique toxicity profile because of prolonged granulocytopenia and increased infectious risk. Aiming at defining specific fitness criteria for the safe use of Venetoclax/HMA, a preliminary investigation was conducted among expert REL hematologists, asking for modifications of SIE/SIES/GITMO criteria they used to select candidates for Venetoclax/HMA. While opinions among experts varied, a general consensus emerged on restricting SIE/SIES/GITMO criteria for ICT-unfit patients to an age limit of 80–85, cardiac function > 40%, and absence of recurrent lung infections, bronchiectasis, or exacerbating COPD. Also, the presence of an adequate caregiver was considered mandatory. Such expert opinions may be clinically useful and may be considered when treatment-specific fitness criteria are updated to include Venetoclax/HMA. Full article
(This article belongs to the Special Issue Recent Research of Geriatric Hematology)
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Review

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12 pages, 1328 KiB  
Review
The Role of Geriatric Assessment in the Management of Diffuse Large B-Cell Lymphoma
by Francesco Merli, Stefano Pozzi, Hillary Catellani, Emiliano Barbieri and Stefano Luminari
Cancers 2023, 15(24), 5845; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15245845 - 14 Dec 2023
Viewed by 1108
Abstract
The treatment choice for an older patient with diffuse large B-cell lymphoma (DLBCL) depends on many other factors in addition to age, which alone does not reflect the complexity of the aging process. Functional features and comorbidity incidence differ not only between younger [...] Read more.
The treatment choice for an older patient with diffuse large B-cell lymphoma (DLBCL) depends on many other factors in addition to age, which alone does not reflect the complexity of the aging process. Functional features and comorbidity incidence differ not only between younger and older patients but also among older patients themselves. The comprehensive geriatric assessment (CGA) quickly evaluates fitness status by investigating the patient’s different functional areas, degree of autonomy, and presence of comorbidities. Various tools are available to evaluate frailty; which assessment tool to use should be based on the clinical aim. The simplified geriatric assessment (sGA) from the elderly project by the Fondazione Italiana Linfomi, prospectively tested on the largest number of patients, categorizes patients as fit, unfit, or frail, with a decreasing rate of overall survival. The elderly prognostic index (EPI), which combines sGA and IPI scores and hemoglobin level, is the first prognostic score for older patients, with three risk groups for survival. Future GAs should consider new parameters, including sarcopenia, which appears to be inversely related to survival. New tools based on prospective studies can help physicians choose the best treatment in light of the individual patient’s characteristics. Full article
(This article belongs to the Special Issue Recent Research of Geriatric Hematology)
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14 pages, 501 KiB  
Review
Supportive Care in Older Lymphoma Patients to Reduce Toxicity and Preserve Quality of Life
by Fulvio Massaro, Fabio Andreozzi, Charlotte Vandevoorde and Dominique Bron
Cancers 2023, 15(22), 5381; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15225381 - 13 Nov 2023
Viewed by 1585
Abstract
The treatment paradigm in older patients with malignant hemopathies is the choice between an effective conservative treatment that preserves quality of life and an intensive, potentially curative treatment with more toxicities. For each patient, it is important to determine the risk/benefit ratio. The [...] Read more.
The treatment paradigm in older patients with malignant hemopathies is the choice between an effective conservative treatment that preserves quality of life and an intensive, potentially curative treatment with more toxicities. For each patient, it is important to determine the risk/benefit ratio. The patient should be involved in the discussion, sufficiently informed and able to express himself and his expectations in terms of quality of life. However, this informed consent is conditioned by the ability of the patient to understand the risks and benefits of the treatment. Decline in quality of life is an important parameter for older patients with cancer and many prospective trials have now confirmed the impact of different side effects of treatment, such as recurrent hospitalization, loss of autonomy in daily activities, loss of contact with grandchildren and loss of cognitive functions. Interventions oriented to vulnerabilities detected in the older patients (by comprehensive geriatric assessment) and an optimal approach, including preventive measures to reduce treatment-related toxicity and mortality, are directly correlated to improvement in quality of life. Full article
(This article belongs to the Special Issue Recent Research of Geriatric Hematology)
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15 pages, 670 KiB  
Review
Sarcopenia Diagnosis and Management in Hematological Malignancies and Differences with Cachexia and Frailty
by Giuseppe Ferdinando Colloca, Andrea Bellieni, Beatrice Di Capua, Marialuisa Iervolino, Serena Bracci, Domenico Fusco, Luca Tagliaferri, Francesco Landi and Vincenzo Valentini
Cancers 2023, 15(18), 4600; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15184600 - 16 Sep 2023
Viewed by 1311
Abstract
Sarcopenia is a geriatric syndrome characterized by a progressive loss of systemic muscle mass and decreased muscle strength or physical function. Several conditions have a role in its pathogenesis, significantly impacting adverse outcomes such as falls, functional decline, frailty, disability, multiple hospitalizations, and [...] Read more.
Sarcopenia is a geriatric syndrome characterized by a progressive loss of systemic muscle mass and decreased muscle strength or physical function. Several conditions have a role in its pathogenesis, significantly impacting adverse outcomes such as falls, functional decline, frailty, disability, multiple hospitalizations, and mortality. In the oncological setting, sarcopenia is associated with an increased risk of treatment toxicity, postoperative complications, and a higher mortality rate related to other causes (e.g., pneumonia). In the hematological field, even more so, sarcopenia predicts toxicity and response to treatments. In patients with hematologic malignancy, low muscle mass is associated with adverse outcomes and is a predictor of overall survival and non-relapse mortality. Therefore, it is essential to correctly recognize sarcopenia, evaluate the risk factors and their impact on the patient’s trajectory, and effectively treat sarcopenia. Sarcopenia is a reversible condition. The most effective intervention for reversing it is physical exercise combined with nutrition. The objective of clinical assessment focused on sarcopenia is to be able to carry out a “tailor-made treatment”. Full article
(This article belongs to the Special Issue Recent Research of Geriatric Hematology)
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20 pages, 886 KiB  
Review
First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era
by Antonio Urso, Francesco Cavazzini, Maria Pia Ballardini, Silvia Gambara, Sara Consolo, Gian Matteo Rigolin and Antonio Cuneo
Cancers 2023, 15(15), 3859; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15153859 - 29 Jul 2023
Viewed by 1751
Abstract
Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion criteria [...] Read more.
Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion criteria are heterogeneous across trials designed for older patients, and the identification of CLL-specific parameters identifying unfit patients at risk of developing drug-specific adverse events is required to guide treatment choice. Due to inclusion/exclusion criteria in trials, higher discontinuation rates with BTKi were reported in real-world studies, and registry analyses provided useful information on factors predicting earlier discontinuation in a real-world setting. Though targeted agents were shown to be cost-effective treatments in high-income countries, the out-of-pocket expenses may limit accessibility to these drugs, and the overall expenditure for new drugs in CLL is projected to increase substantially, posing an issue for sustainability. This being said, the choice of a finite-duration treatment based on venetoclax-containing regimens or treatment until progression with BTKi is today possible in high-income countries, and the therapy choice drivers are represented by coexisting medical conditions rather than age, patient expectations, logistics, and sustainability. Full article
(This article belongs to the Special Issue Recent Research of Geriatric Hematology)
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17 pages, 885 KiB  
Review
New Strategies for the Treatment of Older Myeloma Patients
by Alessandra Larocca, Lorenzo Cani, Giuseppe Bertuglia, Benedetto Bruno and Sara Bringhen
Cancers 2023, 15(10), 2693; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15102693 - 10 May 2023
Viewed by 1776
Abstract
Multiple myeloma (MM) mostly affects older patients, who represent a highly heterogeneous population. In the last few years, the introduction of novel agents led to a significant improvement in the outcome of MM patients. Nonetheless, this positive trend is less likely to occur [...] Read more.
Multiple myeloma (MM) mostly affects older patients, who represent a highly heterogeneous population. In the last few years, the introduction of novel agents led to a significant improvement in the outcome of MM patients. Nonetheless, this positive trend is less likely to occur in all older patients due to comorbidities/disabilities and major susceptibility to toxic events. Furthermore, older patients with major comorbidities are usually excluded or underrepresented in most registrational clinical trials. In this context, physicians have called for greater caution in the management of the disease. Several scores allow for the identification of frail and unfit patients and establish the possibility of tailoring therapy, reducing toxicity. This review explores the available tools for the assessment of frailty and what has been done to improve the discriminative power of the available scores. Thereafter, it describes the main therapeutic strategies for the management of transplant-ineligible (NTE) newly diagnosed (ND) MM patients and relapsed/refractory (RR) MM patients, in order to better guide physicians in choosing treatment options and to suggest possible strategies for more frail patients. Full article
(This article belongs to the Special Issue Recent Research of Geriatric Hematology)
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13 pages, 994 KiB  
Review
Current Treatment Options and the Role of Functional Status Assessment in Classical Hodgkin Lymphoma in Older Adults: A Review
by Vittorio Ruggero Zilioli, Cristina Muzi, Chiara Pagani, Emanuele Ravano, Erika Meli, Rosa Daffini, Erika Ravelli, Roberto Cairoli and Alessandro Re
Cancers 2023, 15(5), 1515; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15051515 - 28 Feb 2023
Viewed by 1494
Abstract
Along with the fact that classical Hodgkin lymphoma (cHL) in older adults is frequently considered biologically different from cHL in younger patients, its most distinctive feature is its dismal clinical outcome due to the decreased effectiveness and greater toxicity of therapies. Although strategies [...] Read more.
Along with the fact that classical Hodgkin lymphoma (cHL) in older adults is frequently considered biologically different from cHL in younger patients, its most distinctive feature is its dismal clinical outcome due to the decreased effectiveness and greater toxicity of therapies. Although strategies to mitigate specific toxicities (e.g., cardiological and pulmonary) have obtained some results, in general, reduced-intensity schemes, proposed as an alternative to ABVD, have proved to be less effective. The addition of brentuximab vedotin (BV) to AVD, especially in a sequential scheme, has demonstrated good efficacy. However, the problem of toxicity persists even with this new therapeutic combination, with comorbidities remaining an important prognostic factor. The adequate stratification of functional status is necessary to distinguish between those patients who will benefit from full treatment and those who will benefit from alternative strategies. A simplified geriatric assessment based on the determination of ADL (activity of daily living), IADL (instrumental ADL), and CIRS-G (Cumulative Illness Rating Scale—Geriatric) scores is an easy-to-use tool that permits adequate patient stratification. Other factors of considerable impact on functional status such as sarcopenia and immunosenescence are currently being studied. A fitness-based treatment choice would also be very useful for relapsed or refractory patients, a more frequent and challenging situation than that is found in young cHL patients. Full article
(This article belongs to the Special Issue Recent Research of Geriatric Hematology)
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