Low-grade lymphomas (other than CLL/SLL) in older patients

The incidence of non-Hodgkin lymphomas has been progressively increasing over the last decades, especially in the elderly. Taken with an aging population, this scenario represents a growing health problem with significant implications for the care of older patients. In fact, because of comorbidities and organ dysfunctions, elderly patients are at an increased risk of therapy-related toxicity. In the setting of indolent lymphomas, even in advanced stages, there is no benefit in terms of outcome in administering early therapy. On the contrary, a “watch and wait” approach represents the standard of care, until specific treatment is indicated. In this case, an accurate evaluation could be made by the comprehensive geriatric assessment (CGA) based on age, comorbidities, and functional disabilities of daily living, which is an important tool to discriminate between fit, unfit, and frail patients. CGA is useful to determine the patient chance of tolerating and responding to therapy, making a whole evaluation of older patients, beyond chronological age itself. The therapeutic goal for elderly patients is to find a balance between effective therapy and related toxicity; therefore, therapy regimens used for younger patients may not be always appropriate for the elderly. When treatment is indicated and feasible, the use of rituximab in combination with chemotherapy is the standard of care in first-line treatment. Furthermore, there is a remarkable number of emerging new drugs which represent valid therapeutic options in relapsed/refractory setting and may allow a chemo-free treatment; therefore, continued participation in clinical trials which include also elderly patients should be recommended.