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Hematological Malignancies in the Elderly: The Epidemiological Perspective

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Management of Hematological Cancer in Older People

Abstract

In the more developed countries the total number of new cases with a hematological tumour was 415,433 for all ages, whilst 188,654 occurred in people aged 70 or more years, representing the 45 % of total cases, equally divided into two sexes. The most these malignancies is closely linked to age and incidence rates increased exponentially after 50 years of age.

Aetiology of hematological tumours is largely unknown. However the basic causal mechanism could be a decline in adaptive immunity, strongly related with individual age. In addition to such immunodeficiency, some specific risk factors have been found: viral infections, overweight and obesity (particularly for non-Hodgkin’s lymphomas – NHL), ionising radiation and chemical compounds (particularly for leukemia). Moreover, it must to be taken into account that mortality and survival, more specifically in the elderly, are influenced negatively by socio-economic deprivation.

Considering geographical distribution, substantial variations in incidence and mortality across the world were observed. Incidence of younger and older adults was for all hematological malignancies higher in more developed countries. As regards mortality, younger people showed rates higher in developing countries, while the elderly in Western and developed areas.

The epidemic growth of NHL incidence was not finished in the first decade of 2000, even if in Italian and US old populations the rates started leveling off. Unlike incidence, mortality was descending in the elderly. Leukemia incidence trends were very often stable or weakly growing, without any tendency to decrease, but for leukemia mortality it was possible to highlight an encouraging general picture with rates often decreasing.

The elderly had always survival rates lower than those of middle aged adults. The prognostic disadvantage was larger at 1 than 5 years from diagnosis. The gap was smaller for NHL and acute myeloid leukemia, whereas the difference in survival was much larger for chronic myeloid leukemia and Hodgkin’s lymphoma. Summarizing, elderly patients had a marked prognostic disadvantage with respect younger adults. However, if an elderly subject survives the first period immediately after detection and overcomes the first difficulties of access to healthcare, experiences a prognosis similar to that of a younger patient.

†Deceased AIRTUM Working Group: R.T. Alto Adige (Guido Mazzoleni), R.T. Trento (Silvano Piffer), R.T. Friuli-Venezia Giulia (Diego Serraino), R.T. Veneto (Sandro Tognazzo), R.T. Mantova (Paolo Ricci), R.T. ASL Milano (Luigi Bisanti), R.T. Lombardia – Varese (Paolo Crosignani), R.T. Brescia (Michele magoni), R.T. Como (Gemma Gola), R.T. Sondrio (Maria Eugenia Sanoja Gonzalez), R.T. Piemonte – Torino (Roberto Zanetti), R.T. Piemonte – Biella (Adriano Giacomin), R.T. Liguria – Genova (Marina Vercelli), R.T. Parma (Maria Michiara), R.T. Reggio Emilia (Lucia Mangone), R.T. Modena (Massimo Federico), R.T. Ferrara (Stefano Ferretti), R.T. Romagna (Fabio Falcini), R.T. Toscano (Adele Caldarella), R.T. Macerata (Susanna Vitarelli), R.T. Umbria (Francesco La Rosa), R.T. Latina (Fabio Pannozzo), R.T. Sassari (Ornelia Sechi), R.T. Nuoro (Mario Usala), R.T. Salerno (Luigi Cremone), R.T. Catanzaro (Antonella Sutera Sardo), R.T. Palermo (Francesco Vitale), R.T. Trapani (Giuseppina Candela), R.T. Catania-Messina (Salvatore Sciacca), R.T. Siracusa (Francesco Tisano), R.T. Ragusa (Rosario Tumino)

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References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr.

    Google Scholar 

  2. Berg SL, Steuber P, Poplack DG. Clinical manifestations of acute lymphoblastic leukemia. In: Hoffman R, Benz Jr EJ, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, editors. Hematology, basic principles and practice. New York: Churchill Livingstone; 2000. p. 1070–8.

    Google Scholar 

  3. Rubnitz JE, Look AT. Pathobiology of acute lymphoblastic leukemia. In: Hoffman R, Benz Jr EJ, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, editors. Hematology, basic principles and practice. New York: Churchill Livingstone; 2000. p. 1052–69.

    Google Scholar 

  4. Allman D, Miller JP. The aging of early B-cell precursors. Immunol Rev. 2005;205:18–29.

    Article  CAS  PubMed  Google Scholar 

  5. Min H, Montecino-Rodriguez E, Dorshkind K. Effects of aging on early B- and T-cell development. Immunol Rev. 2005;205:7–17.

    Article  CAS  PubMed  Google Scholar 

  6. Woolthuis CM, de Haan G, Huls G. Aging of hematopoietic stem cells: intrinsic changes or micro-environmental effects? Curr Opin Immunol. 2011;23(4):512–7.

    Article  CAS  PubMed  Google Scholar 

  7. Johnson KM, Owen K, Witte PL. Aging and developmental transitions in the B cell lineage. Int Immunol. 2002;14:1313–23.

    Article  CAS  PubMed  Google Scholar 

  8. Heng TS, Goldberg GL, Gray DH, Sutherland JS, Chidgey AP, Boyd RL. Effects of castration on thymocyte development in two different models of thymic involution. J Immunol. 2005;175:2982–93.

    Article  CAS  PubMed  Google Scholar 

  9. Stephan RP, Reilly CR, Witte PL. Impaired ability of bone marrow stromal cells to support Blymphopoiesis with age. Blood. 1998;91:75–88.

    CAS  PubMed  Google Scholar 

  10. Solana R, Pawelec G, Tarazona R. Aging and innate immunity. Immunity. 2006;24:491–4.

    Article  CAS  PubMed  Google Scholar 

  11. Weng NP. Aging of the immune system: how much can the adaptive immune system adapt? Immunity. 2006;24:495–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Müller AM, Ihorst G, Mertelsmann R, Engelhardt M. Epidemiology of non-Hodgkin’s lymphoma (NHL): trends, geographic distribution, and etiology. Ann Hematol. 2005;84:1–12.

    Article  PubMed  Google Scholar 

  13. Gale RP, Opelz G. Commentary: does immune suppression increase risk of developing acute myeloid leukemia? Leukemia. 2012;26(3):422–3.

    Article  CAS  PubMed  Google Scholar 

  14. van de Schans SAM, van Spronsen DJ, Hooijkaas H, Janssen-Heijnen MLG, Coebergh JWW. Excess of autoimmune and chronic inflammatory disorders in patients with lymphoma compared with all cancer patients: a cancer registry-based analysis in the south of the Netherlands. Autoimmun Rev. 2011;10:228–34.

    Article  PubMed  Google Scholar 

  15. Seaberg EC, Wiley D, Martínez-Maza O, Chmiel JS, Kingsley L, Tang Y, Margolick JB, Jacobson LP, Multicenter AIDS Cohort Study (MACS). Cancer incidence in the multicenter AIDS Cohort Study before and during the HAART era: 1984 to 2007. Cancer. 2010;116(23):5507–16.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Marcucci F, Mele A. Hepatitis viruses and non-Hodgkin lymphoma: epidemiology, mechanisms of tumorigenesis, and therapeutic opportunities. Blood. 2011;117:1792–8.

    Article  CAS  PubMed  Google Scholar 

  17. Engels EA, Cho ER, Jee SH. Hepatitis B virus infection and risk of non-Hodgkin lymphoma in South Korea: a cohort study. Lancet Oncol. 2010;11(9):827–34.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Kuppers RB. Cells under influence: transformation of B cells by Epstein-Barr virus. Nat Rev Immunol. 2003;3:801–12.

    Article  PubMed  Google Scholar 

  19. Deschler B, Lübbert M. Acute myeloid leukemia: epidemiology and etiology. Cancer. 2006;107:2099–107.

    Article  PubMed  Google Scholar 

  20. Franchini G, Fukumoto R, Fullen JR. T-cell control by human T-cell leukemia/lymphoma virus type 1. Int J Hematol. 2003;78:280–96.

    Article  CAS  PubMed  Google Scholar 

  21. Rodriguez-Abreu D, Bordoni A, Zucca E. Epidemiology of hematological malignancies. Ann Oncol. 2003;18(Supplement 1):i3–8.

    Article  Google Scholar 

  22. Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol. 2006;6:772–83.

    Article  CAS  PubMed  Google Scholar 

  23. Larsson SC, Wolk A. Body mass index and risk of non-Hodgkin’s and Hodgkin’s lymphoma: a meta-analysis of prospective studies. Eur J Cancer. 2011;47:2422–30.

    Article  PubMed  Google Scholar 

  24. Willett EV, Roman E. Obesity and the risk of Hodgkin lymphoma (United Kingdom). Cancer Causes Control. 2006;17:1103–6.

    Article  PubMed  Google Scholar 

  25. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625–38.

    Article  PubMed  Google Scholar 

  26. Samanic C, Gridley G, Chow WH, et al. Obesity and cancer risk among white and black United States veterans. Cancer Causes Control. 2004;15:35–43.

    Article  PubMed  Google Scholar 

  27. Lichtman MA. Obesity and the risk for a hematological malignancy: leukemia, lymphoma, or myeloma. Oncologist. 2010;15:1083–101.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Larsson SC, Wolk A. Overweight and obesity and incidence of leukemia: a meta-analysis of cohort studies. Int J Cancer. 2008;122:1418–21.

    Article  CAS  PubMed  Google Scholar 

  29. Krestinina L, Preston DL, Davis FG, Epifanova S, Ostroumova E, Ron E, Akleyev A. Leukemia incidence among people exposed to chronic radiation from the contaminated Techa River, 1953–2005. Radiat Environ Biophys. 2010;49(2):195–201.

    Article  CAS  PubMed  Google Scholar 

  30. Galbraith D, Gross SA, Paustenbach D. Benzene and human health: a historical review and appraisal of associations with various diseases. Crit Rev Toxicol. 2010;40(S2):1–46.

    Article  PubMed  Google Scholar 

  31. Pearce N, Bethwaite P. Increasing incidence of non-Hodgkin’s lymphoma: occupational and environmental factors. Cancer Res. 1992;52:5496s–500.

    CAS  PubMed  Google Scholar 

  32. Palackdharry CS. The epidemiology of non-Hodgkin’s lymphoma: why the increased incidence? Oncology. 1994;8:67–73.

    CAS  PubMed  Google Scholar 

  33. Zahm SH, Blair A. Pesticides and non-Hodgkin’s lymphoma. Cancer Res. 1992;52:5485s–8.

    CAS  PubMed  Google Scholar 

  34. Gojo I, Karp JE. The impact of biology on the treatment of secondary AML. Cancer Treat Res. 2001;108:231–55.

    Article  CAS  PubMed  Google Scholar 

  35. Bentham G. Association between incidence of non-Hodgkin’s lymphoma and solar ultraviolet radiation in England and Wales. Br Med J. 1996;312:1128–31.

    Article  CAS  Google Scholar 

  36. Freedman DM, Zahm SH, Dosemeci M. Residential and occupational exposure to sunlight and mortality from non-Hodgkin’s lymphoma: composite (threefold) case–control study. Br Med J. 1997;314:1451–5.

    Article  CAS  Google Scholar 

  37. Sasieni P, Bataille V. Non-Hodgkin’s lymphoma and skin cancer. Ultraviolet light is unlikely explanation for association. Br Med J. 1995;311:749.

    Article  CAS  Google Scholar 

  38. Hu S, Ma F, Collado-Mesa F, Kirsner RS. Ultraviolet radiation and incidence of non-Hodgkin’s lymphoma among. Hispanics in the United States. Cancer Epidemiol Biomarkers Prev. 2004;13:59–64.

    Article  CAS  PubMed  Google Scholar 

  39. Quaglia A, Lillini R, Mamo C, Ivaldi E, Vercelli M, SEIH (Socio-Economic Indicators, Health) Working Group. Socio-economic inequalities: a review of methodological issues and the relationships with cancer survival. Crit Rev Oncol Hematol. 2013;85:266–77.

    Article  PubMed  Google Scholar 

  40. Vercelli M, Villini R, Capocaccia R, Micheli A, Coebergh JWW, Quinn M, Martinez-Garcia C, Quaglia A, The ELDCARE Working Group. Cancer survival in the elderly: Effects of socio-economic factors and health care system features (ELDCARE project). Eur J Cancer. 2006;42:234–42.

    Article  PubMed  Google Scholar 

  41. Frederiksen BL, Dalton SO, Osler M, Steding-Jessen M, de Nully Brown P. Socioeconomic position, treatment, and survival of non-Hodgkin lymphoma in Denmar - - nationwide study. Br J Cancer. 2012;106(5):988–95 [Epub 2012 Feb 7].

    Google Scholar 

  42. Bhayat F, Das-Gupta E, Smith C, McKeever T, Hubbard R. The incidence of and mortality from leukaemias in the UK: a general population-based study. BMC Cancer. 2009;9:252–8.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Kristinsson SY, Derolf AR, Edgren G, Dickman PW, Bjo¨rkholm M. Socioeconomic differences in patient survival Are increasing for acute myeloid leukemia and multiple myeloma in Sweden. J Clin Oncol. 2009;27:2073–80.

    Article  PubMed  Google Scholar 

  44. Ferlay J, Parkin DM, Curado MP, Bray F, Edwards B, Shin HR, Forman D. Cancer Incidence in Five Continents, Volumes I to IX: IARC CancerBase No. 9 [Internet]. Lyon: International Agency for Research on Cancer; 2010. Available from: http://ci5.iarc.fr.

    Google Scholar 

  45. Newton R, Ferlay J, Beral V, Devesa SS. The epidemiology of non-Hodgkin’s lymphoma: comparison of nodal and extra-nodal sites. Int J Cancer. 1997;72:923–30.

    Article  CAS  PubMed  Google Scholar 

  46. Anderson JR, Armitage JO, Weisenburger DD. Epidemiology of the non-Hodgkin’s lymphomas: distributions of the major subtypes differ by geographic locations. Non-Hodgkin’s lymphoma classification project. Ann Oncol. 1998;9:717–20.

    Article  CAS  PubMed  Google Scholar 

  47. Sukpanichnant S, Sonakul D, Piankijagum A, Wanachiwanawin W, Veerakul G, Mahasandana C, Tanphaichitr VS, Suvatte V. Malignant lymphoma in Thailand: changes in the frequency of malignant lymphoma determined from a histopathologic and immunophenotypic analysis of 425 cases at Siriraj Hospital. Cancer. 1998;83:1197–204.

    Article  CAS  PubMed  Google Scholar 

  48. Lymphoma Study Group of Japanese Pathologists. The World Health Organization classification of malignant lymphomas in Japan: incidence of recently recognized entities. Pathol Int. 2000;50:696–702.

    Article  Google Scholar 

  49. Echimane AK, Ahnoux AA, Adoubi I, Hien S, M’Bra K, D’Horpock A, Diomande M, Anongba D, Mensah-Adoh I, Parkin DM. Cancer incidence in Abidjan, Ivory Coast: first results from the cancer registry, 1995–1997. Cancer. 2000;89:653–63.

    Article  CAS  PubMed  Google Scholar 

  50. World Health Organization, mortality database http://www.who.int/whosis/mort/download/en/index.html.

  51. ISTAT. Geo-Demo. Demography in figures, http://demo.istat.it/.

  52. Joinpoint Regression Program, Version 3.3.1. April 2008; Statistical Research and Applications Branch, National Cancer Institute. U.S.A.

    Google Scholar 

  53. McKean-Cowdin R, Feigelson HS, Ross RK, Pike MC, Henderson BE. Declining cancer rates in the 1990s. J Clin Oncol. 2000;18:2258–68.

    CAS  PubMed  Google Scholar 

  54. Armitage JO, Bierman PJ, Bociek RG, Vose JM. Lymphoma 2006: classification and treatment. Oncology (Williston Park). 2006;20:231–9.

    Google Scholar 

  55. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J. Lymphoma classification—from controversy to consensus: the R.E.A.L. and WHO Classification of lymphoid neoplasms. Ann Oncol. 2000;11:3–10.

    Article  PubMed  Google Scholar 

  56. Jaffe E, Harris NL, Stein H, Vardiman J. World Health Organization classification of tumours: pathology and genetics of tumours of hematopoietic and lymphoid tissue. Lyon: IARC; 2001.

    Google Scholar 

  57. Brenner H, Gefeller O. An alternative approach to monitoring 591 cancer patient survival. Cancer. 1996;78:2004–10.

    Article  CAS  PubMed  Google Scholar 

  58. Surveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 7.1.0.

  59. Quaglia A, Tavilla A, Shack L, Brenner H, Janssen-Heijnenf M, Allemani C, Colonna M, Grande E, Grosclaude P, Vercellia M and the EUROCARE Working Group. The cancer survival gap between elderly and middle-aged patients in Europe is widening. Eur J Cancer. 2009;45:1006–16.

    Google Scholar 

  60. Quaglia A, Capocaccia R, Micheli A, Carrani E, Vercelli M and the EUROCARE-3 Working Group. A wide difference in cancer survival between middle aged and elderly patients in Europe. Int J Cancer. 2007;120:2196–201

    Google Scholar 

  61. Janssen-Heijnen ML, Maas HA, Houterman S, Lemmens VE, Rutten HJ, Coebergh JW. Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer. 2007;43:2179–93.

    Article  PubMed  Google Scholar 

  62. Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to ECOG performance status in elderly cancer patients: an Italian group for geriatric oncology study. J Clin Oncol. 2002;20:494–502.

    Article  PubMed  Google Scholar 

  63. Bouchardy C, Rapiti E, Fioretta G, et al. Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol. 2003;21:3580–7.

    Article  PubMed  Google Scholar 

  64. Fentiman IS. Are the elderly receiving appropriate therapy for cancer? Ann Oncol. 1996;7:657–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Health Sciences, University of Genoa, Italy, Genoa, Italy

    Marina Vercelli PHD

  2. IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto, Nazionale per la Ricerca sul Cancro, Genoa, Italy

    Roberto Lillini PHD

  3. Department of Sociology, University of Milan-Bicocca, Milan, Italy

    Roberto Lillini PHD

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  1. Alberto Quaglia
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  2. Marina Vercelli PHD
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  3. Roberto Lillini PHD
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AIRTUM Working Group

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Correspondence to Marina Vercelli PHD .

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Editors and Affiliations

  1. Department of Palliative Care, University Hospital Jena, Jena, Thüringen, Germany

    Ulrich Wedding

  2. St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom

    Riccardo A. Audisio

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Quaglia, A., Vercelli, M., Lillini, R., AIRTUM Working Group. (2015). Hematological Malignancies in the Elderly: The Epidemiological Perspective. In: Wedding, U., Audisio, R. (eds) Management of Hematological Cancer in Older People. Springer, London. https://doi.org/10.1007/978-1-4471-2837-3_1

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  • DOI: https://doi.org/10.1007/978-1-4471-2837-3_1

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