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Diagnosis and management of haematological malignancies in older people

  • Helen Marr (a1), Gail L Jones (a1), Graham H Jackson (a1) and Wendy Osborne (a1)


The incidence of most haematological malignancies increases with age. Given that those aged >65 years represent the fastest growing segment of Western populations, these cancers may commonly present to medical teams with an interest in older patients. Over the last 20 years there have been dramatic improvements in the outlook for patients diagnosed with haematological cancers, but there is evidence that many of these improvements have been restricted to younger patients. It is therefore important that older patients with haematological malignancies are rapidly diagnosed and promptly treated with the best available therapies. Clinical trials that specifically encompass older patients are clearly important. In this review, the presentation and management of common haematological malignancies will be discussed, including myelodysplasia, acute leukaemia, lymphoproliferative disorders and myeloma.


Corresponding author

Address for correspondence: Dr Gail L Jones, Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN. Email:


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1Jarrett, RF, Stark, GL, White, J, Angus, B, Alexander, FE, Krajewski, AS, Freeland, J, Taylor, GM, Taylor, PR; Scotland and Newcastle Epidemiology of Hodgkin Disease Study Group. Impact of tumour Epstein-Barr virus status on presenting features and outcome in age-defined subgroups of patients with classical Hodgkin lymphoma: a population-based study. Blood 2005; 106: 2444–51.
2Appelbaum, FR, Gundacker, H, Head, DR, Slovak, ML, Willman, CL, Godwin, JE, Anderson, JE, Petersdorf, SH. Age and acute myeloid leukaemia. Blood 2006; 107: 3481–85.
3Kennedy, BJ, Loeb, V, Peterson, VM, Donegan, WL, Natarajan, N, Mettlin, C. National survey of patterns of care for Hodgkin's disease. Cancer 1985; 56: 2547–56.
4Clarke, CA, Glaser, SL, Dorfman, RF, Mann, R, DiGiuseppe, JA, Prehn, AW, Ambinder, RF. Epstein-Barr virus and survival after Hodgkin disease in a population-based series of women. Cancer 2001; 91: 1579–87.
5Stark, GL, Wood, KM, Jack, F, Angus, B, Proctor, SJ, Taylor, PR. Hodgkin's disease in the elderly: a population-based study. Br J Haematol 2004; 119: 432–40.
6van der Holt, B, Breems, DA, Berna Beverloo, H, van den Berg, E, Burnett, AK, Sonneveld, P, Löwenberg, B. Various distinctive cytogenetic abnormalities in patients with acute myeloid leukaemia aged 60 years and older express adverse prognostic value. Results from a prospective clinical trial. Br J Haematol 2007; 136: 96105.
7Leith, CP, Kopecky, KJ, Godwin, J, McConnell, T, Slovak, ML, Chen, IM, Head, DR, Appelbaum, FR, Willman, CL. Acute myeloid leukaemia in the elderly: assessment of multidrug resistance (MDR1) and cytogenetics distinguishes biological subgroups with remarkably distinct responses to standard chemotherapy. A southwest oncology group study. Blood 1997; 89: 3323–29.
8Aapro, MS, Cameron, DA, Pettengell, R, Bohlius, J, Crawford, J, Ellis, M, Kearney, N, Lyman, GH, Tjan-Heijnen, VC, Walewski, J, Weber, DC, Zielinski, C; European Organisation for Research and Treatment of Cancer (EORTC). Granulocyte Colony-Stimulating Factor (G-CSF) Guidelines Working Party. EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 2006; 42: 2433–53.
9Proctor, SJ, Wilkinson, J. A web-based study concept designed to progress clinical research for ‘orphan’ disease area in haematological oncology in the elderly: the SHIELD programme. Crit Rev Oncol Haematol 2007; 61: 7983.
10Juliusson, G, Antunovic, P, Derolf, A, Lehmann, S, Möllgård, L, Stockelberg, D, Tidefelt, U, Wahlin, A, Höglund, M. Age and acute myeloid leukaemia: real world data on decision to treat and outcomes from the Swedish Acute Leukaemia Registry. Blood 2009; 113: 4179–87.
11Arber, DA, Brunning, RD, LeBeau, MM et al. Acute myeloid leukaemia and related precursors neoplasms. In Swerdlo, H, Campo, E, Harris, NL et al. (eds), WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (4th edn). Lyon: International Agency for Research on Cancer, 2008; pp. 110147.
12Burnett, AK, Milligan, D, Goldstone, A, Prentice, A, McMullin, MF, Dennis, M, Sellwood, E, Pallis, M, Russell, N, Hills, RK, Wheatley, K; United Kingdom National Cancer Research Institute Haematological Oncology Study Group. The impact of dose escalation and resistance modulation in older patients with acute myeloid leukaemia and high risk myelodysplastic syndrome: the results of the LRF AML14 trial. Br J Haematol 2009; 145: 318–32.
13Klepin, HD, Balducci, L. Acute myelogenous leukaemia in older adults. Oncologist 2009; 14: 222–32.
14Ciurea, SO, Rodrigues, M, Geralt, S, de Lima, M. Aging, acute myelogenous leukaemia and allogeneic transplantation: do they belong in the same sentence? Clin Lymphoma Myeloma 2009; 9: 289–97.
15Williamson, PJ, Kruger, AR, Reynolds, PJ, Hamblin, TJ, Oscier, DG. Establishing the incidence of myelodysplastic syndromes. Br J Haematol 1994; 87: 743–45.
16Greenberg, P, Cox, C, LeBeau, MM, Fenaux, P, Morel, P, Sanz, G, Sanz, M, Vallespi, T, Hamblin, T, Oscier, D, Ohyashiki, K, Toyama, K, Aul, C, Mufti, G, Bennett, J. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 1997; 89: 2079–88.
17Tefferi, A, Stone, RM. Iron chelation therapy in myelodysplastic syndrome – Cui bono? Leukemia 2009; 23: 1373.
18Sekeres, MA, List, AF. Active treatment strategies improving outcomes in patients with myelodysplastic syndromes with the deletion 5q abnormality. Clin Leukaemia 2008; 2: 2833.
19List, A, Kurtin, S, Roe, DJ, Buresh, A, Mahadevan, D, Fuchs, D, Rimsza, L, Heaton, R, Knight, R, Zeldis, JB. Efficacy of lenalidomide in myelodysplastic synromes. N Engl J Med 2005; 352: 549–57.
20Seymour, JF, Fenaux, P, Silverman, LR, Mufti, GJ, Hellström-Lindberg, E, Santini, V, List, AF, Gore, SD, Backstrom, J, McKenzie, D, Beach, CL. Effects of azacitadine compared with conventional care regimens in the elderly (>=75 years) patients with higher-risk myelodysplastic syndromes. Crit Rev Oncol Hematol 2010; 76: 218–27.
21Kantarjian, HM. Treatment of myelodysplastic syndrome: questions raised by the azacitidine experience. J Clin Oncol 2002; 20: 2415–16.
22Wijermans, P, Suciu, S, Baila, L et al. Low dose decitabine versus best supportive care in elderly patients with intermediate or high risk MDS not eligible for intensive chemotherapy: Final results of the randomized phase III study (06011) of the EORTC Leukaemia and German MDS Study Groups. Abstract. Blood 2008; 112: 226a.
23Roy, P, Vaughan Hudson, G, Vaughan Hudson, B et al. A comparison of relative survival in patients in trials and those recorded in population-based cancer registries. Eur J Cancer 2000; 36: 384–89.
24Levis, A, Anselmo, AP, Ambrosetti, A, Adamo, F, Bertini, M, Cavalieri, E, Gavarotti, P, Genua, A, Liberati, M, Pavone, V, Pietrasanta, D, Ricetti, MM, Scalabrini, DR, Salvi, F, Vitolo, U, Angelucci, E, Boccadoro, M, Gallo, E, Mandelli, F; Intergruppo Italiano Linfomi (IIL). VEPEMB in elderly Hodgkin's lymphoma patients. Results from an Intergruppo Italiano Linfomi (IIL) study. Ann Oncol 2004; 15: 123–28.
25Hasenclever, D, Diehl, V. A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's disease. N Engl J Med 1998; 339: 1506–14.
26Erdkamp, FL, Breed, WP, Bosch, LJ, Wijnen, JT, Blijham, GB. Hodgkin's disease in the elderly, a registry-based analysis. Cancer 1992; 70: 830–34.
27Engert, A, Ballova, V, Haverkamp, H, Pfistner, B, Josting, A, Dühmke, E, Müller-Hermelink, K, Diehl, V; German Hodgkin's Study Group. Hodgkin's lymphoma in elderly patients: A comprehensive retrospective analysis from the German Hodgkin's Study Group. J Clin Oncol 2005; 23: 5052–60.
28Ballova, V, Rüffer, JU, Haverkamp, H, Pfistner, B, Müller-Hermelink, HK, Dühmke, E, Worst, P, Wilhelmy, M, Naumann, R, Hentrich, M, Eich, HT, Josting, A, Löffler, M, Diehl, V, Engert, A. A prospectively randomized trial carried out by the German Hodgkin Study Group for elderly patients with advanced Hodgkin's disease comparing BEACOPP baseline and COPP-ABVD (study HD9 elderly) Ann Oncol 2005; 16: 124–31.
29The Non Hodgkin's Lymphoma Classification Project. Effect of age on the characteristics and behaviour of non-Hodgkin's lymphoma patients. Ann Oncol 1997; 8: 973–78.
30The International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med 1993; 329: 987–94.
31Coiffier, B, Lepage, E, Briere, J, Herbrecht, R, Tilly, H, Bouabdallah, R, Morel, P, Van Den Neste, E, Salles, G, Gaulard, P, Reyes, F, Lederlin, P, Gisselbrecht, C. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large B cell lymphoma. N Engl J Med 2002; 346: 235–42.
32Pfreundschuh, M, Schubert, J, Ziepert, M. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol 2008; 9: 105–16.
33Pfreundschuh, M. How I treat elderly patients with diffuse large B cell lymphoma. Blood 2010; 116: 5103–10.
34Hershman, DL, McBride, RB, Eisenberger, A, Tsai, WY, Grann, R, Jacobson, JS. Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse large B cell lymphoma. J Clin Oncol 2008; 26: 3159–65.
35Smith, TJ, Khatcheressian, J, Lyman, GH, Ozer, H, Armitage, JO, Balducci, L, Bennett, CL, Cantor, SB, Crawford, J, Cross, SJ, Demetri, G, Desch, CE, Pizzo, PA, Schiffer, CA, Schwartzberg, L, Somerfield, MR, Somlo, G, Wade, JC, Wade, JL, Winn, RJ, Wozniak, AJ, Wolff, AC. 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 2006; 24: 3187–205.
36Gribben, JG. How I treat indolent lymphoma. Blood 2007; 109: 4617–26.
37Solal-Céligny, P, Roy, P, Colombat, P, White, J, Armitage, JO, Arranz-Saez, R, Au, WY, Bellei, M, Brice, P, Caballero, D, Coiffier, B, Conde-Garcia, E, Doyen, C, Federico, M, Fisher, RI, Garcia-Conde, JF, Guglielmi, C, Hagenbeek, A, Haïoun, C, LeBlanc, M, Lister, AT, Lopez-Guillermo, A, McLaughlin, P, Milpied, N, Morel, P, Mounier, N, Proctor, SJ, Rohatiner, A, Smith, P, Soubeyran, P, Tilly, H, Vitolo, U, Zinzani, PL, Zucca, E, Montserrat, E. Follicular Lymphoma International Prognostic Index. Blood 2004; 104: 1258–65.
38Pulte, D, Gondos, A, Brenner, H. Ongoing improvement in outcomes for patients diagnosed as having non-Hodgkin lymphoma from the 1990s to the early 21st century. Arch Int Med 2008; 168: 469–76.
39Marcus, R, Imrie, K, Belch, A, Cunningham, D, Flores, E, Catalano, J, Solal-Celigny, P, Offner, F, Walewski, J, Raposo, J, Jack, A, Smith, P. CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood 2005; 105: 1417–23.
40Salles, G, Seymour, JF, Offner, F, López-Guillermo, A, Belada, D, Xerri, L, Feugier, P, Bouabdallah, R, Catalano, JV, Brice, P, Caballero, D, Haioun, C, Pedersen, LM, Delmer, A, Simpson, D, Leppa, S, Soubeyran, P, Hagenbeek, A, Casasnovas, O, Intragumtornchai, T, Fermé, C, da Silva, MG, Sebban, C, Lister, A, Estell, JA, Milone, G, Sonet, A, Mendila, M, Coiffier, B, Tilly, H. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3 randomised controlled trial. Lancet 2010; 377: 4251.
41Hernandez, JA, Land, KJ, McKenna, RW. Leukaemia myeloma and other lymphoreticular neoplasms. Cancer 1995; 75: 381–94.
42Mauro, FR, Foa, R, Cerretti, R, Giannarelli, D, Coluzzi, S, Mandelli, F, Girelli, G. Autoimmune haemolytic anaemia in chronic lymphocytic leukaemia: clinical, therapeutic, and prognostic features. Blood 2000; 95: 2786–92.
43Diehl, LF, Ketchum, LH. Autoimmune disease and chronic lymphocytic leukaemia: autoimmune haemolytic anaemia, pure red cell aplasia, and autoimmune thrombocytopenia. Semin Oncol 1998; 25: 8097.
44Molica, S, Alberti, A. Prognostic value of lymphocyte doubling time in chronic lymphocytic leukaemia. Cancer 1987; 60: 2712–16.
45Tsimberidou, AM, Keating, MJ. Richter syndrome: biology, incidence and therapeutic strategies. Cancer 2005; 103: 216–28.
46French Co-operative Group on Chronic Lymphocytic Leukemia. Effects of chlorambucil and therapeutic decisions in initial forms of chronic lymphocytic leukaemia (stage A): results of randomised clinical trials on 612 patients. Blood 1990; 75: 1414–21.
47Paneesha, S, Milligan, DW. Stem cell transplantation for chronic lymphocytic leukaemia. Br J Haematol 2005; 128: 145–52.
48Rawstron, AC, Bennett, FL, O'Connor, SJ, Kwok, M, Fenton, JA, Plummer, M, de Tute, R, Owen, RG, Richards, SJ, Jack, AS, Hillmen, P. Monoclonal B-cell lymphocytosis and chronic lymphocytic leukaemia. N Engl J Med 2008; 359: 575–83.
49Kyle, RA, Therneau, TM, Rajkumar, SV, Larson, DR, Plevak, MF, Offord, JR, Dispenzieri, A, Katzmann, JA, Melton, LJ 3rd. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med 2006; 354: 362–69.
50British Committee for Standards in Haematology in conjunction with the UK Myeloma Forum (UKMF). Guidelines on the diagnosis and management of multiple myeloma 2010. Available at: (accessed 17 February 2011).
51Palumbo, A, Bringhen, S, Caravita, T, Merla, E, Capparella, V, Callea, V, Cangialosi, C, Grasso, M, Rossini, F, Galli, M, Catalano, L, Zamagni, E, Petrucci, MT, De Stefano, V, Ceccarelli, M, Ambrosini, MT, Avonto, I, Falco, P, Ciccone, G, Liberati, AM, Musto, P, Boccadoro, M; Italian Multiple Myeloma Network, GIMEMA. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trial. Lancet 2006; 367: 825–31.
52San Miguel, JF, Schlag, R, Khuageva, NK, Dimopoulos, MA, Shpilberg, O, Kropff, M, Spicka, I, Petrucci, MT, Palumbo, A, Samoilova, OS, Dmoszynska, A, Abdulkadyrov, KM, Schots, R, Jiang, B, Mateos, MV, Anderson, KC, Esseltine, DL, Liu, K, Cakana, A, van de Velde, H, Richardson, PG; VISTA Trial Investigators. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 2008; 359: 906–17.
53Palumbo, A, Falco, P, Falcone, A, Benevolo, G, Canepa, L, Gay, F, Larocca, A, Magarotto, V, Gozzetti, A, Luraschi, A, Morabito, F, Nozza, A, Knight, RD, Zeldis, JB, Boccadoro, M, Petrucci, MT. Melphalan, prednisone, and lenalidomide for newly diagnosed myeloma: kinetics of neutropenia and thrombocytopenia and time-to-event results. Clin Lymphoma Myeloma 2009; 9: 145–50.



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