How I treat older patients with relapsed/refractory diffuse large B-cell lymphoma

Area of Science:

• Hematology
• Oncology
• Geriatric Medicine

Background:

• Diffuse large B-cell lymphoma (DLBCL) is an aggressive cancer, with older adults facing higher relapse risks.
• Comorbidities and reduced eligibility for intensive treatments complicate care for elderly DLBCL patients.
• Novel therapies offer new options, but careful patient selection and management are crucial.

Purpose of the Study:

• To summarize management strategies for older patients with relapsed or refractory DLBCL.
• To discuss the role of fitness assessments and novel therapeutic options in this population.
• To provide guidance on selecting and administering treatments for elderly DLBCL patients.

Main Methods:

• Review of current treatment landscape for relapsed/refractory DLBCL in older adults.
• Discussion of geriatric assessment integration into treatment decisions.
• Summary of novel therapeutic approaches including CAR T-cell therapy, bispecific antibodies, and targeted agents.

Main Results:

• Chimeric antigen receptor T-cell therapy is an option for fit older patients.
• Several novel agents and combinations (e.g., tafasitamab/lenalidomide, polatuzumab, loncastuximab tesirine) show promise with potential modifications for older adults.
• Geriatric assessments are critical but require further guidance in the relapsed setting.

Conclusions:

• Managing older patients with relapsed DLBCL requires a personalized approach, balancing novel therapies with patient fitness.
• Careful consideration of comorbidities and treatment intensity is essential for optimizing outcomes.
• Ongoing research and clinical guidance are needed to refine treatment strategies for this vulnerable population.