Cure rate in the elderly patients with diffuse large B cell lymphoma deteriorates after the age of 80—results from a single-center survey

Abstract

The prognosis of elderly patients diagnosed with diffuse large B cell lymphoma (DLBCL) is considered to be clearly inferior to that of younger patients. Besides tumor biology and comorbidities, treatment selection due to an assumed reduced tolerability may contribute to this difference. With increasingly more patients diagnosed at advanced age, current treatment selections need to be reviewed carefully. Hence, we analyzed the results of patients above the age of 70 in whom a diagnosis of DLBCL was made. Whereas patients up to 80 were frequently selected for and were able to tolerate standard treatment (86% intended use, 74% completion), patients above the age of 80 years were not only treated more cautiously (67 and 60%, respectively) but did show inferior response to treatment with standard treatment (CR rate for intended R-CHOP use 64% vs. 43%). However, on an individual level, patients receiving and completing standard treatment obtained results that resemble the results of younger patients, irrespective if aged more than 80 and impose superior to prior reports in this age cohort. Median PFS for the entire group of patients was 3.44 years, with 4.83 years for patients below 80 and only 1.09 years for patients above the age of 80. The corresponding figures for OS were 7.38 years (estimated); after 2 years, OS was 81% in the younger cohort in contrast to 68% in patients > 80 years. However, for patients not planned to receive or not tolerating R-CHOP, results remain poor; tailored approaches for these patients are required.

Skeletal muscle index impacts the treatment outcome of elderly patients with diffuse large B cell lymphoma

“…Notably, compared to the R-IPI, the ESPI demonstrated the ability to identify intermediate-risk groups and showed a trend toward increased predictive accuracy. Although several studies showed age was a prognostic factor in elderly DLBCL, 38,39 patients were treated by various regimens in the previous cohorts. In our study, in which R-CHOP was performed in most patients, the prognostic impact of age was diminished when sarcopenia was considered a risk factor.…”

Chimeric antigen receptor‐T cell therapy shows similar efficacy and toxicity in patients with diffuse large B‐cell lymphoma aged 70 and older compared to younger patients: A multicenter cohort study

“…Consequently, nearly 60% of older DLBCL patients do not achieve a cure following first-line treatment, thus requiring salvage therapies. 4,9 Until recently, the clinical management of relapsed or refractory (r/r) DLBCL patients largely relied on their eligibility for high-dose therapy and autologous stem cell transplantation (auto-HSCT). Meanwhile, building on the positive results of two randomized prospective studies showing favorable results of CD19-directed chimeric antigen receptor (CAR)-T cells compared to auto-HSCT, r/r DLBCL patients deemed CAR-T cell eligible predominantly receive one of the approved CAR-T cell products: Axi-cel (Axicabtagene ciloleucel) or Liso-cel (Lisocabtagene maraleucel).…”

“…Also, elderly DLBCL patients often prove ineligible for full‐dose cytotoxic immunochemotherapy, rendering them more susceptible to treatment discontinuation or compromises due to treatment‐related side effects. Consequently, nearly 60% of older DLBCL patients do not achieve a cure following first‐line treatment, thus requiring salvage therapies 4,9 …”

“…Consequently, nearly 60% of older DLBCL patients do not achieve a cure following first‐line treatment, thus requiring salvage therapies. 4 , 9 …”

LncRNA OR2A1‐AS1 index predicts survival in germinal center‐like diffuse large B‐cell lymphoma

“…Diffuse large B‐cell lymphoma (DLBCL) is a highly aggressive form of non‐Hodgkin lymphoma (NHL) 1–3 and is considered to be diverse in terms of biological, clinical, and pathological features 3–5 . The curative and survival rate was considerably enhanced in DLBCL patients by adding rituximab to CHOP (cyclophosphamide, rituximab, vincristine, doxorubicin, and prednisone) chemotherapy 6,7 .…”