Approach to therapy of diffuse large B-cell lymphoma in the elderly: the International Society of Geriatric Oncology (SIOG) expert position commentary

• Published in: Annals of oncology Vol. 26; no. 6; pp. 1058 - 1068
• Main Authors: Morrison, V.A., Hamlin, P., Soubeyran, P., Stauder, R., Wadhwa, P., Aapro, M., Lichtman, S.M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-06-2015
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; B-cell lymphoma; chemoimmunotherapy; Comorbidity; elderly; frailty; Geriatric Assessment; Geriatrics - standards; Humans; Immunotherapy - adverse effects; Immunotherapy - methods; large cell lymphoma; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - immunology; Lymphoma, Large B-Cell, Diffuse - mortality; Lymphoma, Large B-Cell, Diffuse - therapy; Medical Oncology - standards; Middle Aged; Neoplasm Staging; Patient Selection; radiation therapy; Radiotherapy - adverse effects; Recurrence; Remission Induction; Risk Factors; Treatment Outcome; Young Adult; chemoimmunotherapy; frailty; elderly; large cell lymphoma; radiation therapy; B-cell lymphoma
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdv018

Diffuse large B-cell lymphoma (DLBCL) is a treatable and potentially curable malignancy that is increasing in prevalence in the elderly. Until recently, older patients with this malignancy were under-represented on clinical treatment trials, so optimal therapeutic approaches for these patients were generally extrapolated from the treatment of younger patients with this disorder. Because of heightened toxicity concerns, older patients were sometimes given reduced dose therapy, potentially negatively impacting outcome. Geriatric considerations including functional status and comorbidities often were not accounted for in treatment decisions. Because of these issues as well as the lack of treatment guidelines for the elderly population, the International Society of Geriatric Oncology convened an expert panel to review DLBCL treatment in the elderly and develop consensus guidelines for therapeutic approaches in this patient population. The following treatment guidelines address initial DLBCL therapy, in both limited and advanced stage disease, as well as approaches to the relapsed and refractory patient.