Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive but potentially curable disease and is most common in older
people. Rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) is the standard of care for fit
patients without cardiac contraindications. In each individual older patient, the potential gains of treatment should be
balanced against the risks of treatment-related morbidity and mortality. A simplified comprehensive geriatric
assessment or easily performed assessments such as gait speed and grip strength can be helpful to assess the fitness
of an older patient. Prephase with corticosteroids, rigorous supportive care including granulocyte colony-stimulating
factor prophylaxis and careful monitoring can be important in preventing adverse events. In unfit older patients, a
dynamic dosing strategy is often applied. For very old patients (≥80 years) a dose-reduced regimen (rituximabminiCHOP) is recommended. When anthracyclines are contraindicated, doxorubicin can be replaced by etoposide or
gemcitabine. Most frail patients do not benefit from chemotherapy. Further progress can be expected from
non-chemotherapy-based therapies, such as bispecific antibodies, antibody-drug conjugates, and immunomodulatory
agents. This article provides an overview of first line treatment in older patients with DLBCL and our approach to the
management of these challenging cases.
people. Rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) is the standard of care for fit
patients without cardiac contraindications. In each individual older patient, the potential gains of treatment should be
balanced against the risks of treatment-related morbidity and mortality. A simplified comprehensive geriatric
assessment or easily performed assessments such as gait speed and grip strength can be helpful to assess the fitness
of an older patient. Prephase with corticosteroids, rigorous supportive care including granulocyte colony-stimulating
factor prophylaxis and careful monitoring can be important in preventing adverse events. In unfit older patients, a
dynamic dosing strategy is often applied. For very old patients (≥80 years) a dose-reduced regimen (rituximabminiCHOP) is recommended. When anthracyclines are contraindicated, doxorubicin can be replaced by etoposide or
gemcitabine. Most frail patients do not benefit from chemotherapy. Further progress can be expected from
non-chemotherapy-based therapies, such as bispecific antibodies, antibody-drug conjugates, and immunomodulatory
agents. This article provides an overview of first line treatment in older patients with DLBCL and our approach to the
management of these challenging cases.
| Original language | English |
|---|---|
| Pages (from-to) | 2566-2575 |
| Number of pages | 10 |
| Journal | Blood |
| Volume | 141 |
| Issue number | 21 |
| DOIs | |
| Publication status | Published - 25 May 2023 |
Bibliographical note
Funding Information:The authors thank Jeanette Doorduijn, hematologist, for her critical review of the final version of the manuscript. Contribution: P.J.L. conceived, wrote, and reviewed the paper; and P.G.N.J.M. wrote and reviewed the paper.
Publisher Copyright:
© 2023 The American Society of Hematology