Determination of the appropriate chemotherapy for patients aged 80 years or older with diffuse large B cell lymphoma

Abstract The optimal chemotherapy for newly diagnosed (ND) diffuse large B-cell lymphoma (DLBCL) in patients aged 80 years or older has not been conclusively determined. Due to the expected toxicities and comorbidities in this age group, intensifying the dosages of chemotherapy may not always be a viable solution. However, undertreating the disease based solely on a patient’s frailties can lead to disease progression, and patients often succumb to the disease in routine practices. This retrospective study was conducted to determine whether there is an optimal regimen for elderly DLBCL patients. We selected ND-DLBCL patients aged 80 years or older and excluded those who did not receive chemotherapies or those who received treatment other than combinations of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or rituximab and bendamustine (BR). We assessed the efficacies, survival outcomes, and toxicity according to the regimen, including standard-dose R-CHOP, R-miniCHOP, and BR. The patients who received the standard dose of R-CHOP presented a better overall response rate (ORR) than those who received R-miniCHOP. Moreover, there was no significant difference in progression-free survival (PFS, p = 0.581) or overall survival (OS, p = 0.693) among the patients who received standard-dose R-CHOP, R-miniCHOP, or BR. The patients with Eastern Cooperative Oncology Group performance status of 0–1, serum albumin ≥ 3.5 g/dL, early stage, and GCB subtype were associated with superior PFS and OS. The incidence of any grade or grade ≥ 3 neutropenia was reported in patients who received the standard dose of R-CHOP, but there were no significant differences in treatment-related mortality across the regimens. Nevertheless, the patients who addressed adverse events and followed the planned treatment schedules seemed to achieve better treatment survival outcomes. No single superior regimen was found for DLBCL patients ≥80 years. These insights provide valuable guidance for tailoring treatment strategies to optimize outcomes for elderly DLBCL patients, particularly those with poor health conditions and specific phenotypic characteristics. Thus, comprehensive evaluation before chemotherapy initiation needs to be performed for better survival outcomes.