Treatment of elderly patients with diffuse large B-cell lymphoma
With the implementation of rituximab, tremendous progress has been achieved in the treatment of diffuse large B-cell lymphoma (DLBCL). Nevertheless, the majority of patients with DLBCL are over the age of 65 years and the management of these patients is often suboptimal. Standard chemo-immunotherapy with curative approach should be appropriate for all elderly patients who can tolerate it. Therefore, a careful evaluation of each patient is mandatory prior to treatment allocation. R- CHOP regimen (rituximab, cyclophosphamide doxorubicin, vincristine, prednisolone) remains the standard of care, but special attention has to be paid to rigorous supportive care. Patients not fit enough for R-CHOP are candidates for dose-reduced therapy or other palliative strategies.
Non-Hodgkin lymphoma (NHL) is increasingly common in developed countries and diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype. The incidence rises from 2 cases/100,000 below the age of 25 years, to 45 cases/100,000 at the age of 60 years and about 100 cases/100,000 above the age of 80. Also, the number of elderly individuals is progressively rising. An appropriate cut-off age characterizing elderly lymphoma patients is arbitrary, but the upper age limit for autologous transplantation strategies (65–70 years) seems to be reasonable.
While DLBCL is a potentially curable disease, evidence suggests that elderly patients do worse than their younger counterparts. These inferior outcomes may reflect undertreatment resulting from oncologists’ perception that elderly patients are unable to tolerate aggressive therapy. Thus, comorbidities that are common in the elderly might preclude the use of curative regimens that predispose some patients to life-threatening complications. In addition, the majority of elderly patients are usually not eligible for clinical trials.