Considerations for the Treatment of Diffuse Large B Cell Lymphoma in the Elderly

Purpose of Review Diffuse large B cell lymphoma (DLBCL) is a curable and common malignancy in elderly population. Elderly patients, especially those 80 and older, have poor outcomes compared with those < 60. This may be due to the disease biology, comorbidities, and/or functional limitations. Recent Findings Prospective data, and especially randomized data, are limited. The FIL tool objectively categorizes patients as fit, unfit, or frail. Fit and unfit patients can benefit from chemoimmunotherapy with curative intent. Evidence guiding treatment of frail patients is limited, but it appears that frail patients have similar survival regardless of treatment with curative or palliative intent. Summary For fit and unfit patients, treatment options include rituximab with dose-attenuated CHOP or regimens with adriamycin alternatives if there is concern for cardiovascular adverse effects (AEs). Frail patients are extremely sensitive to toxicity from therapies. Frail patients and those 80 and older could greatly benefit from trials incorporating novel agents.