With improvements in medical care and the resultant positive impact on life expectancy over the past few decades, the proportion of the population aged .65 years has seen significant increase, with the very elderly (age .80 years) expressed as a percentage of those aged .65 years almost doubling since 1950 (13.3% in 1950 increasing to 25.3% in 2015). 1 Like most cancers, the probability of acquiring non-Hodgkin lymphoma (NHL) increases with age (0.2% to 0.3% in those aged ,50 years and 1.4% to 1.8% in those aged .69 years). 2 Moreover, recent statistics also suggest an increase in the incidence of NHL, especially among men. 2 Because the mean age at diagnosis of diffuse large B-cell lymphoma (DLBCL) is 70 years, 3 there has been a number of studies focusing on the elderly with DLBCL, more so after the introduction of rituximab (R), the monoclonal antibody directed against CD-20 on B cell. 4 However, a majority of patients in these studies were in the age group of 60 to 80 years, 5-7 and the very elderly (age .80 years) were mostly not part of these studies due to their multiple comorbidities, poor performance status, or concerns about chemotherapy-induced toxicities that preclude optimizing therapy. 8-10 Hence, there is a lack of definite consensus regarding treatment of DLBCL in the 801 age group. However, due to the increase in life expectancy and increase in incidence of NHL, especially DLBCL, among octogenarians, there have been a few recent studies, mostly retrospective, dealing with patients in this age group. 11-13 Some of these studies have shown improved survival outcomes when standard therapy with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is used rather than observation or suboptimal therapy, whereas others showed better survival and tolerability with less toxic non-anthracycline-based therapy or dose reduction in various components of R-CHOP. 14,15 However, there are little data on DLBCL on those aged .90 years. 16
