Prognosis and management strategies of lymphatic neoplasias in the elderly. I. Aggressive non-Hodgkin's lymphomas.
Lymphomas belong to the class of malignant diseases with the fastest increasing incidence. High-grade non-Hodgkin's lymphomas (NHL) display a peak of incidence in the age group above 65. In the last few years, age has been recognized as a major risk factor for overall survival of high-grade NHL patients, and numerous attempts have been made to analyze the contribution of factors to the age-related worsening of prognosis in this disease, e.g. the biology of the disease on the one hand, and age-specific comorbidity or degree of cytotoxicity, reluctance in diagnosis and treatment and socioeconomic factors on the other. Furthermore, age-adapted treatment protocols have been designed and tested for their practicability and efficacy in the elderly. Very recently, large randomized prospective clinical trials have been carried out which support the idea that treatment with a curative intent is warranted even in the very elderly and that a successful attempt to cure requires the use of full-dose anthracycline-containing regimens closely similar to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). In addition, progress has been made in systematically defining maximally tolerated doses of the cytotoxic drugs and in specifically testing anthracyclines with reduced cardiotoxicity with an efficacy similar to that of doxorubicin, and further in investigating the advantage of applying hematopoietic growth factors and/or cardioprotective drugs in this older population. In limited stages of disease, three cycles of CHOP chemotherapy followed by involved field irradiation may be superior to radiotherapy and prolonged chemotherapy and may produce highly satisfying cure rates.