Treatment of older patients with chronic lymphocytic leukemia: key questions and current answers

AbstractDespite the advanced age at onset, chronic lymphocytic leukemia (CLL) shortens the life expectancy of the majority of newly diagnosed patients. The management of elderly patients with CLL is more complex than that of younger patients due to the greater frequency of comorbidities and functional impairment as well as reduced organ function. Many of the recent advances in the care of CLL patients (prognostication, more intense combination therapy regimens) are of unclear relevance for elderly patients. This review addresses 5 key questions in the management of elderly patients with CLL: (1) why is classifying the “fitness” of CLL patients necessary; (2) what criteria should be used to classify patient fitness; (3) when should elderly patients be treated; (4) how should therapy be selected for elderly patients; and (5) which therapy is best (for this patient)?

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Clinical Characteristics and Outcome of Young Chronic Lymphocytic Leukemia Patients: A Single Institution Study of 204 Cases

Blood ◽

10.1182/blood.v94.2.448 ◽

1999 ◽

Vol 94 (2) ◽

pp. 448-454 ◽

Cited By ~ 147

Author(s):

Francesca R. Mauro ◽

Robert Foa ◽

Diana Giannarelli ◽

Iole Cordone ◽

Sabrina Crescenzi ◽

...

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Clinical Features ◽

Median Survival ◽

Survival Probability ◽

Older Patients ◽

Lymphocytic Leukemia ◽

Second Primary ◽

Age Group ◽

Single Institution ◽

Younger Patients

Abstract A retrospective analysis on chronic lymphocytic leukemia (CLL) patients ≤55 years observed at a single institution was performed with the purpose of characterizing the clinical features and outcome of young CLL and of identifying patients with different prognostic features. Over the period from 1984 to 1994, 1,011 CLL patients (204 [20%] ≤55 years of age and 807 [80%] >55 years of age) were observed. At diagnosis, younger and older patients displayed a similar distribution of clinical features, except for a significantly higher male/female ratio in younger patients (2.85 v 1.29;P < .0001). Both groups showed an elevated rate of second primary cancers (8.3% v 10.7%), whereas the occurrence of Richter’s syndrome was significantly higher in younger patients (5.9% v 1.2%; P < .00001). Younger and older patients showed a similar overall median survival probability (10 years) but were characterized by a different distribution of causes of deaths: CLL unrelated deaths and second primary malignancies predominated in the older age group, whereas the direct effects of leukemia were prevalent in the younger age group. Although younger and older patients displayed a similar survival, the evaluation of the relative survival rates showed that the disease had a greater adverse effect on the expected survival probability of the younger population. Multivariate analysis showed that for young CLL patients only dynamic parameters, such as lymphocyte doubling time and other signs of active disease, were the independent factors that significantly influenced survival probability (P = .00001). A prolonged clinico-hematologic follow-up allowed us to identify two subsets of young CLL patients with a different prognostic outcome: a group of patients (40%) with long-lasting stable disease without treatment and an actuarial survival probability of 94% at 12 years from diagnosis and another group (60%) with progressive disease and a median survival probability of 5 years after therapy. For the latter patients, the therapeutic effect of innovative therapies with curative intents needs to be investigated in prospective, comparative clinical trials.

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Treatment of Younger Patients with Chronic Lymphocytic Leukemia

Hematology ◽

10.1182/asheducation-2010.1.82 ◽

2010 ◽

Vol 2010 (1) ◽

pp. 82-89 ◽

Cited By ~ 6

Author(s):

Alessandra Ferrajoli

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Minimal Residual Disease ◽

Residual Disease ◽

Lymphocytic Leukemia ◽

Consolidation Therapy ◽

Newly Diagnosed ◽

Therapeutic Approaches ◽

Early Referral ◽

Younger Patients ◽

Minimal Residual

Abstract Younger patients (defined as patients younger than 50–55 years of age) represent a small group of newly diagnosed patients with chronic lymphocytic leukemia, accounting only for 10% to 20% of newly diagnosed cases. However, once these patients become symptomatic and require treatment, their life expectancy is significantly reduced. Therapeutic approaches for younger patients should be directed at improving survival by achieving a complete remission and, where possible, eradicating minimal residual disease. Chemoimmunotherapy combinations carry the highest response rates and are commonly offered to younger patients. Additional strategies that should be considered for younger patients include early referral for stem-cell transplantation and clinical trials of consolidation therapy to eliminate minimal residual disease.

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Clinical Characteristics and Outcome of Young Chronic Lymphocytic Leukemia Patients: A Single Institution Study of 204 Cases

Blood ◽

10.1182/blood.v94.2.448.414k13_448_454 ◽

1999 ◽

Vol 94 (2) ◽

pp. 448-454

Author(s):

Francesca R. Mauro ◽

Robert Foa ◽

Diana Giannarelli ◽

Iole Cordone ◽

Sabrina Crescenzi ◽

...

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Clinical Features ◽

Median Survival ◽

Survival Probability ◽

Older Patients ◽

Lymphocytic Leukemia ◽

Second Primary ◽

Age Group ◽

Single Institution ◽

Younger Patients

A retrospective analysis on chronic lymphocytic leukemia (CLL) patients ≤55 years observed at a single institution was performed with the purpose of characterizing the clinical features and outcome of young CLL and of identifying patients with different prognostic features. Over the period from 1984 to 1994, 1,011 CLL patients (204 [20%] ≤55 years of age and 807 [80%] >55 years of age) were observed. At diagnosis, younger and older patients displayed a similar distribution of clinical features, except for a significantly higher male/female ratio in younger patients (2.85 v 1.29;P < .0001). Both groups showed an elevated rate of second primary cancers (8.3% v 10.7%), whereas the occurrence of Richter’s syndrome was significantly higher in younger patients (5.9% v 1.2%; P < .00001). Younger and older patients showed a similar overall median survival probability (10 years) but were characterized by a different distribution of causes of deaths: CLL unrelated deaths and second primary malignancies predominated in the older age group, whereas the direct effects of leukemia were prevalent in the younger age group. Although younger and older patients displayed a similar survival, the evaluation of the relative survival rates showed that the disease had a greater adverse effect on the expected survival probability of the younger population. Multivariate analysis showed that for young CLL patients only dynamic parameters, such as lymphocyte doubling time and other signs of active disease, were the independent factors that significantly influenced survival probability (P = .00001). A prolonged clinico-hematologic follow-up allowed us to identify two subsets of young CLL patients with a different prognostic outcome: a group of patients (40%) with long-lasting stable disease without treatment and an actuarial survival probability of 94% at 12 years from diagnosis and another group (60%) with progressive disease and a median survival probability of 5 years after therapy. For the latter patients, the therapeutic effect of innovative therapies with curative intents needs to be investigated in prospective, comparative clinical trials.

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Quality of life, depression and anxiety in chronic lymphocytic leukemia during phases of “watchful waiting” and active treatment

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.6603 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 6603-6603

Author(s):

T. Levin

Keyword(s):

Quality Of Life ◽

Chronic Lymphocytic Leukemia ◽

Lymphocytic Leukemia ◽

Depression And Anxiety ◽

Newly Diagnosed ◽

Watch And Wait ◽

Younger Patients ◽

Component Score ◽

Social And Emotional

6603 Background: Although chronic lymphocytic leukemia (CLL) accounts for 25–30% of leukemia cases in the USA, little is known about its quality of life (QOL) and psychosocial burden. The purpose of this study was to compare QOL, anxiety and depression in watch and wait versus actively treated CLL. Methods: Using a cross-sectional design, 105 patients were recruited from a CLL research database. 57 were classified as watch and wait and 48 as receiving or having received chemotherapy for CLL. The patients completed a battery of QOL measures including the SF-36, FACT-Lym, Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI) and the Patient Health Questionnaire. Results: No differences were found between the treatment groups on the main QOL outcome measures - Mental Component Score, Physical Component Score, FACT-G, FACT-lymphoma (15 item), BDI-II and BAI. There was a clear age effect: younger patients (<60 years old) have worse Mental Component (p=0.0001), FACT-G (p=0.060), depression (p=0.014), Role Emotional (p=0.042), Mental Health (p=0.001), FACT-Emotional (p=0.0001) and FACT-Social (p=0.002) scores. Younger watch and wait patients seem to be particularly vulnerable to anxiety (p=0.052). Social and emotional QOL are statistically similar in both newly diagnosed and patients diagnosed six or more years ago, although patients do carry a greater physical QOL burden with time (p=0.05). Conclusions: Overall QOL, depression and anxiety are remarkably similar in watch and wait versus actively treated CLL, despite the latter group having, by definition, later stage disease. Younger patients (<60 years old) seem particularly vulnerable to having a reduced emotional and social QOL and having more depression. Younger watch and wait patients stood out as suffering from more anxiety. Patients diagnosed for more than 6 years carry a greater physical QOL burden, but social and emotional QOL are similar to newly diagnosed patients. Implications of these findings are considered. [Table: see text] No significant financial relationships to disclose.

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Faculty Opinions recommendation of First-line therapy with fludarabine compared with chlorambucil does not result in a major benefit for elderly patients with advanced chronic lymphocytic leukemia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1162774.624372 ◽

2009 ◽

Author(s):

Ulrich Wedding

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Elderly Patients ◽

Lymphocytic Leukemia ◽

First Line ◽

First Line Therapy ◽

Major Benefit ◽

Line Therapy

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ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

Wiadomości Lekarskie ◽

10.36740/wlek201908109 ◽

2019 ◽

Vol 72 (8) ◽

pp. 1466-1472

Author(s):

Grażyna Kobus ◽

Jolanta Małyszko ◽

Hanna Bachórzewska-Gajewska

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Acute Renal Failure ◽

Elderly Patients ◽

Older Patients ◽

Age Groups ◽

Kidney Injury ◽

The Elderly ◽

Younger Patients ◽

Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

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