Diffuse Large B-cell Lymphoma in the elderly: standard treatment and new perspectives

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common histotype in non Hodgkin lymphoma, with a peak incidence in the sixth decade. The standard treatment for elderly FIT DLBCL patients is Rituximab-CHOP; in unfit and frail patients, chemotherapy at reduced intensity should be considered. Areas covered: In this article, we will review use of standard therapies and new drugs investigated such as immonomudulating agents (IMiDs), Bruton Tyrosine Kinase (BTK), in fit, unfit, frail and very elderly DLCBL patients. Expert commentary: R-CHOP21 in fit DLBCL patients is still the standard of care, while in elderly unfit patients a reduction of doses of cytotoxic drugs or schemes that avoid antracycline should be considered. The Comprensive Geriatric Assesment based in age, comorbidities and functional abilities of daily living is an important tool in elderly, in order to discriminate between fit, unfit or frail patients. Novel drugs represent valid therapeutic options in relapsed/refractory setting so continued participation in clinical trials should be encouraged.

Outcome after high‐dose chemotherapy and autologous stem cell transplantation in patients with aggressive B‐cell non‐Hodgkin's lymphoma

“…Furthermore, it should be considered that the majority of patients evaluated in the current study (63%) have not received rituximab during induction treatment, which represents the current standard of treatment in patients with B-NHL. [27][28][29] Moreover, as positron emission tomography (PET) CT was not performed for response assessment, the number of CRs might be underestimated in the current study. This becomes particularly evident, when comparing the rate of PRs in the upfront HDT/ABSCT DLBCL cohort (n = 20, 43%) and the rate of relapses in this subgroup (n = 6, 12%),…”

“…In the overall cohort, relapses were reported in 15 of 72 patients Median days to leukocytes ≥1.0×10 9 /L (range) 11 (7-32) 11 (7-16) 12 .682 11 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) 12 (9-16) 11 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) .379…”

Rozpoznawanie i leczenie chorych na chłoniaka rozlanego z dużych komórek B

“…Postępowanie u chorych w podeszłym wieku W przypadku DLBCL za wiek podeszły uznaje się przekroczenie 65. roku życia, po osiągnięciu którego chorzy zwykle nie mogą być kandydatami do auto-HSCT/RIC-allo-HSCT. Zachorowania w tym wieku częściej charakteryzują podgrupa molekularna ABC-DLBCL, wariant immunoblastyczny i zależność onkogenezy od upośledzenia odporności i/lub zakażenia EBV [52,93]. Dlatego rokowanie w tej grupie chorych jest gorsze od obserwowanego u młodszych chorych, tym bardziej że intensywność dawki stosowana u młodszych chorych jest zwykle większa.…”

“…rż. ), poza koniecznością rozważenia stosowania profilaktyki przeciwinfekcyjnej lewofloksacyną, kotrimoksazolem i acyklowirem [60,93]. Konieczne może być monitorowanie stanu chorego i częstsze wizyty kontrolne między kolejnymi cyklami CTH, zwłaszcza na początku leczenia, w celu szybszego wychwycenia powikłań narządowych, w tym gorączki neutropenicznej, zespołu lizy guza i innych.…”

Lenalidomide maintenance for diffuse large B‐cell lymphoma patients responding to R‐CHOP: quality of life, dosing, and safety results from the randomised controlled REMARC study

“…Diffuse large B‐cell lymphoma (DLBCL) is the most frequent type of aggressive non‐Hodgkin lymphoma (NHL) (Friedberg, ; Chiappella et al , ) with incidence peaking in the sixth decade of life (Chiappella et al , ). The combination regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R‐CHOP) is considered standard first‐line therapy for patients with DLBCL and is given with curative intent (Chiappella et al , ,b; Davies, ). Patients with DLBCL who are event‐free at 24 months have a subsequent overall survival (OS) equivalent to that of the age‐ and sex‐matched general population (Maurer et al , ).…”