Is blood aging?

Blog Post by Lodovico Balducci, M.D., H. Lee Moffitt Cancer Center & Research Institute, Florida

Blood is the crossroad of all bodily changes. Blood may age and certainly blood reflects the physiologic aging of a person, not unlike a river that reflects the degree of pollution of an industrialized nation. The novel goal of the ESH First International Conference on Haematological Malignancies in the Elderly taking place in Lisbon on July 2-4 is twofold: to assess the age of a person through the exam of his/her blood, and to manage effectively the hematological malignancies that are becoming more and more common with age. The conference will start with an overview of aging through the special perspective of anemia: anemia is a consequence of aging due to aging erythropoieis, due to aging related nutritional deficit (iron, cobalamin, and copper), due to chronic renal insufficiency and chronic inflammation that are both hallmarks of aging. Anemia is associated with increased risk of mortality and functional dependence, that is anemia mirrors the physiologic age of the individual. In about 50% of the cases anemia is reversible and its reversal may delay the aging process. A special form of anemia, myelodysplasia, may represent the aging of the hemopoietic stem cells and of the hemopoietic stroma. New advances in the treatment of myelodysplasia are particularly germane to the management of the older person. The assessment of aging involves clinical and laboratory assessment. Based on the geriatric assessment we can predict a person’s life-expectancy and tolerance of stress. Frailty is a condition of increased susceptibility to environmental stress that puts the older individuals to increased risk of therapeutic complications. To a certain extent frailty and its complications may be delayed. The assessment of the concentration of inflammatory cytokines in the circulation and of the so called “allostatic load” are promising research techniques that in a non distant future may provide us with an estimate of individual age more accurate than the clinical evaluation. The incidence of most hematological malignancies increases with age, and yet the information related to the management of acute leukemia, chronic lymphocytic leukemia and multiple myeloma in the elderly is scarce and inadequate. New forms of treatment including thalidomide and lenalidomide, antimethylating agents and histone deacetylase inhibitors, proteosome inhibitors, and minitransplant may play a major role in improving the prognosis of these disorders in the elderly. The conference will review supportive care, including the role of the home caregiver in the management of the older aged person, will emphasize prolongation of active life expectancy as a major treatment goal and will collect patient testimony. The conference will foster the cooperation of hematologists, geriatricians, nurses and other health professional in the management of older patients with hematological malignancy. This cooperative model of care has already been very effective in the management of cancer in the older person.

Cambridge University Press published a landmark textbook of geriatric hematology: Blood Disorders in the Elderly edited by Lodovico Balducci M.D., one of the conference directors. This conference promises to expand the effort to familiarize hematologists and geriatricians with issues that are becoming way more common in their respective practices.

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