Chronic Lymphocytic Leukemia in Chronic Lymphocytic

Chronic Lymphocytic Leukemia In Chronic Lymphocytic-Free PDF

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Table of Contents, Why a Special Issue on Chronic Lymphocytic Leukemia 2. Lodovico Balducci MD,Chronic Lymphocytic Leukemia in the Elderly 3. Epidemiology and Proposed Patient Related Approach. Lodovico Balducci MD and Dawn Dolan PharmD,Chronic Lymphocytic Leukemia in the Elderly 7. Which Investigations Are Necessary A Map for the Practicing Oncologist. Javier Pinilla Ibarz MD PhD and Josephine Emole MD. Management of Chronic Lymphocytic Leukemia in the Elderly 17. Jacqueline C Barrientos MD,About the art in this issue. Lisa Scholder is a multimedia artist whose canvas is the human body Her technique involves applying body paint onto nude models then digitally photo. graphing the painted body The explosion of illuminating color on the human form is Scholder s artistic trademark All of the models shown in this issue are. breast cancer survivors of varying ages and body types and they are part of the Bodies of Courage project. Scholder takes several hours to hand paint the model with a cr me based paint and often incorporates other body painted images in the final piece. which does not include the face of her model Her artwork focuses on the abstract portrayal of the body infused with vibrant colors Scholder s late father in. law renowned Indian artist Fritz Scholder had an unmistakable influence on her bold color combinations Each model s unique strength is represented with. abstract and at times expressionist art forms on her body The artist s driving force is the self empowerment that this process can bestow on her model. enabling her to see her body as a colorful unique piece of art. With no formal art training she began body painting in 2000 and developed her distinct body painting and photography style Her first public exhibition. was in 2004 and she has progressed to gallery and art museum exhibitions. Bodies of Courage is an Arts in Medicine project www bodiesofcourage org in partnership with the Faces of Courage Foundation www facesof. courage org which provides at no cost day outings and overnight camps for women children and families diagnosed with any type of cancer Lisa. Scholder and Peggie D Sherry the founder of Faces of Courage began this project 5 years ago as a way to raise awareness and as an artistic therapy for. cancer survivors This project is an artistic testimony to the strength and determination of these survivors throughout their battles with cancer their celebra. tion of life and their reconnection with the beauty of their own bodies. For information about the traveling gallery please contact Peggie D Sherry at psherry facesofcourage org or 813 948 7478 Further information on. these projects is available at www bodiesofcourage org and www facesofcourage org. Cover Self Hug Sit 12 18,Articles Color Sphere 12 18.
Yellow Star Port 14 24,Sunflower 16 24, Cancer Control Journal of the Moffitt Cancer Center ISSN 1073 2748 is published by H Lee Moffitt Cancer Center Research Institute 12902 Magnolia Drive Tampa FL 33612. Telephone 813 745 1348 Fax 813 449 8680 E mail ccjournal Moffitt org Internet address cancercontroljournal org Cancer Control is included in Index Medicus MEDLINE and EMBASE. Excerpta Medica Thomson Reuters Science Citation Index Expanded SciSearch and Journal Citation Reports Science Edition Copyright 2015 by H Lee Moffitt Cancer Center Research Institute. All rights reserved, Cancer Control Journal of the Moffitt Cancer Center is a peer reviewed journal that is published to enhance the knowledge needed by professionals in oncology to help them minimize the. impact of human malignancy Each issue emphasizes a specific theme relating to the detection or management of cancer The objectives of Cancer Control are to define the current state of. cancer care to integrate recently generated information with historical practice patterns and to enlighten readers through critical reviews commentaries and analyses of recent research studies. Disclaimer All articles published in this journal including editorials and letters represent the opinions of the author s and do not necessarily reflect the opinions of the editorial board the. H Lee Moffitt Cancer Center Research Institute Inc or the institutions with which the authors are affiliated unless clearly specified The reader is advised to independently verify the effective. ness of all methods of treatment and the accuracy of all drug names dosages and schedules Dosages and methods of administration of pharmaceutical products may not be those listed in. the package insert and solely reflect the experience of the author s and or clinical investigator s. October 2015 Vol 22 No 4 Supplement Cancer Control 1. Why a Special Issue on Chronic Lymphocytic Leukemia. The aging of the population which has been called with 17p deleted TP53 mutated disease and it. the gray tsunami 1 has at least three important im may be life saving for older individuals with. plications for the practice of oncology this type of CLL Idelalisib is also promising in. It is associated with increased incidence and this context. prevalence of neoplastic diseases in general and The most important questions include. in older individuals in particular Should clinicians try to achieve a condition of. The ongoing prolongation of the average life minimal residual disease MRD in older CLL pa. expectancy of residents of developed countries tients Is MRD predictive of survival in patients. has changed the impact of cancer on the survival treated with novel agents compared with those. of older patients Whereas in the past most older treated with cytotoxic chemotherapy How can. individuals diagnosed with chronic lymphocytic the benefit of MRD best be determined in older. leukemia CLL or prostate cancer might have individuals with limited life expectancy and treat. died with the disease but of other causes nowa ment tolerance. days they are more likely to die as a direct con Can the novel agents achieve the same results. sequence of these neoplasms 2 3 and with decreased toxicity as FCR or benda. How to treat neoplastic diseases in older individ mustine plus rituximab BR in older individuals. uals is becoming a progressively more common What are the long term complications of these. concern among healthcare providers 4 novel treatments Since treated CLL patients. CLL is an appropriate model to explore these may have a life expectancy of longer than a. issues as age is universally recognized to be a poor decade the late complications of treatment are. prognostic factor for CLL 2 and novel agents prom particularly relevant to their survival and qual. ise to modify the natural history of the disease 5 6 ity of life. Some of these agents including ibrutinib idelalisib Overall this supplement invites readers to feel a. obinutuzumab and ofatumumab lack major toxici sense of cautious optimism for the outcome of CLL. ties and therefore are particularly promising for older in older individuals and this optimism should be. individuals Aging represents a progressive loss in the reinforced by the ongoing development of new less. functional reserve of multiple organ systems and for toxic and more efficacious albeit more expensive. that reason is associated with reduced tolerance of treatment modalities. stress Consequently some of the most effective treat. ments for CLL such as the combination of fludarabine Lodovico Balducci MD. cyclophosphamide and rituximab FCR or bone mar Senior Member. row transplant in 17p deleted TP53 mutated disease Program Leader Senior Adult Oncology Program. may be contraindicated in the majority of individuals Editor Cancer Control. 70 years of age and older 5 6 H Lee Moffitt Cancer Center Research Institute. After an overview of the epidemiology2 and treat Tampa Florida. ment strategies6 for CLL this special issue of Cancer Lodovico Balducci Moffitt org. Control examines the approach to CLL in older in, dividuals 5 As expected in a scientific treatise new References. conclusions and new questions are offered 1 Wheelwright J The gray tsunami Discover Magazine 2012 Avail. able at http discovermagazine com 2012 oct 20 the gray tsunami Accessed. The most important conclusions include November 2 2015. CLL is lethal for the majority of older individu 2 Balducci L Dolan D Chronic lymphocytic leukemia in the elderly. epidemiology and proposed patient related approach Cancer Control. als who develop it before age 80 and there are 2015 22 4 suppl 3 6. reasons to believe that it may be lethal even up 3 Stephenson RA Prostate cancer trends in the era of prostate specific. antigen An update of incidence mortality and clinical factors from the SEER. to age 85 2 database Urol Clin North Am 2002 29 173 181. New agents including obinutuzumab ofatu 4 Colloca G Corsonello A Marzetti E et al Treating cancer in older. and oldest old patients Curr Pharm Des 2015 21 1699 1705. mumab ibrutinib and idelalisib have improved 5 Pinilla Ibarz J Emole J Chronic lymphocytic leukemia in the elderly. the survival of older individuals even among which investigations are necessary a map for the practicing oncologist. Cancer Control 2015 22 4 suppl 7 16, those affected with moderate comorbidity 2 5 6 6 Barrientos JC Management of chronic lymphocytic leukemia in the. Ibrutinib is the only approved agent for patients elderly Cancer Control 2015 22 4 suppl 17 23. 2 Cancer Control October 2015 Vol 22 No 4 Supplement. More accurate tools to assess frailty and,physiologic age will play an increasingly.
important role in the management of elderly,chronic lymphocytic leukemia patients. Photo courtesy of Lisa Scholder Color Sphere 12 18. Chronic Lymphocytic Leukemia in the Elderly, Epidemiology and Proposed Patient Related Approach. Lodovico Balducci MD and Dawn Dolan PharmD, Background Chronic lymphocytic leukemia CLL occurs primarily in the elderly and the majority of deaths. attributable to CLL occur in persons 65 years of age or older The greater number of comorbidities and reduced. functionality associated with aging have also made successful treatment of CLL in the elderly more difficult. Methods The authors reviewed current epidemiology and guidelines for treatment of CLL as well as recently. approved therapies and studies of physiological aging. Results Determination of physiological age and performance of a thorough geriatric assessment play critical. roles in the selection of optimal therapeutic approaches for older patients diagnosed with CLL. Conclusion Older age expressed via a frailty index is a prognostic factor for poorer outcome in patients. with CLL However several novel treatment options may result in reduced mortality and lessened treatment. related toxicity in older CLL patients, Introduction addition treatment advances that are prolonging the. Chronic lymphocytic leukemia CLL is a disease of ag survival of the majority of patients will contribute to in. ing According to the most recent statistics there are creased CLL survival in this population 3. approximately 15 000 new cases of CLL in the United This article reviews the influence of CLL on the life. States every year and half of them occur in individuals expectancy and the function of older individuals and. 71 years and older 1 Persons 65 years of age and older appropriate treatment strategies for them. account for 60 of the annual deaths attributed to CLL. and for 70 of the approximately 150 000 CLL patients CLL and Life Expectancy. currently alive With the rapid aging of the popula Contrary to a common impression the majority of old. tion the incidence and prevalence of CLL among older er CLL patients die of the disease rather than with it. persons may be expected to continue to increase 2 In Age has been shown to be an independent adverse fac. tor for survival in two prognostic models Table 1 4 5. From the Senior Adult Oncology Program LB and Pharmacy In a group of Israeli patients Bairey et al6 demonstrat. Service DD H Lee Moffitt Cancer Center Research Institute ed that age greater than 80 years was associated with. Tampa Florida,Submitted April 23 2015 accepted October 26 2015.
poorer CLL specific survival vs younger individuals In. Address correspondence to Lodovico Balducci MD Moffitt Can a review of 2 487 cases of CLL diagnosed at the Mayo. cer Center 12902 Magnolia Drive Tampa FL 33612 E mail Clinic between 1995 and 2008 Shanafelt et al7 report. Lodovico Balducci Moffitt org ed that age at diagnosis was an independent prognos. Dr Balducci is a consultant for and receives honoraria from Teva tic factor for survival Even patients with Rai stage 0 at. Pharmaceuticals He also receives honoraria from Amgen Astel. las Pharma and Johnson Johnson Dr Dolan is a speaker for diagnosis had a shorter survival than individuals of the. and receives honoraria from Eisai same age without CLL indicating that CLL is indeed a. October 2015 Vol 22 No 4 Supplement Cancer Control 3. with decreased tolerance of chemotherapy and poorer. Table 1 Prognostic Models of Chronic survival in patients with multiple myeloma The find. Lymphocytic Leukemia, ings of this study may imply that poor treatment toler. Factor MD Bulian ance may be responsible for decreased survival even in. Anderson Prognostic older patients with CLL, Prognostic Index 5 This brief review suggests the following con. CLL is a cause of death for older individuals es, Sex P P pecially for those aged 80 years and older Older. Beta 2 microglobulin concentration P P individuals may benefit from more effective novel. individuals diagnosed with chronic lymphocytic leukemia CLL Lymphocytic Leukemia 4 in A Leukemia Leukemia Leukemia

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