Hematologic Malignancies

Older adults have increased incidence and prevalence of a variety of benign and malignant hematologic disorders. They range from common anemia and age-related clonal hematopoiesis to aggressive acute myeloid leukemia and high-grade lymphoma. Management of these patients can be challenging given highly prevalent, age-related comorbidities, functional impairment, and reduced physiologic reserve. Comprehensive geriatric assessment is increasingly incorporated into the clinical management of patients with hematologic malignancies, hematopoietic cell transplantation, and cellular therapy. Several geriatric assessment domains such as functional deficit, mobility impairment, cognitive dysfunction and multi-morbidity have been shown to be prognostic of survival, treatment tolerance, toxicities, and healthcare resource utilization across many hematologic malignancies. Comprehensive geriatric assessment not only risk stratify but also help identify potentially remediable geriatric vulnerabilities and should be considered as the standard of care for older patients with advanced hematologic malignancies. In additional, treatment-related functional decline and quality of life are important considerations for older adults, and ideally are evaluated through comprehensive geriatric assessment, timely prognostic communication, and shared-decision making. While we await randomized evidence supporting a geriatric assessment-guided, risk-adapted treatment strategy for older patients with hematologic malignancies, it is perceivable that geriatric assessment-directed, targeted supportive care interventions will be crucial components in a longitudinal, integrated, collaborated model of care between hematologic oncologists and geriatricians/ geriatric oncologists to improve older patient outcomes.