Diffuse large B-cell lymphomas in older adults

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in the elderly and is increasing in incidence. Although significant therapeutic advances have recently been made in the care of older DLBCL patients, based upon results of randomized clinical trials, many older patients are not eligible for such trials due to comorbidities and functional decline. Pretreatment evaluation of older patients to ascertain potential tolerance to therapy is especially important in therapeutic decisions for this population. Evaluation by performance status alone is insufficient, especially in the elderly, and consideration of the impact of comorbidities and functional/social decline needs to be included in such assessment. In this chapter, we will review approaches to therapy of the older patients with DLBCL, including initial treatment, role of maintenance therapy, use of combined modality therapy for limited stage disease, and strategies for the relapsed/refractory older patient. We will also address the issues of prognosis, comorbidities, geriatric assessment, supportive care measures in older patients with DLBCL, and recommendations for assessment and allied care.