Poor outcome of older patients with diffuse large B-cell lymphoma after progression

One-third of the patients with diffuse large B-cell lymphoma (DLBCL) experience relapse despite receiving standard R-CHOP chemotherapy. We aimed to elucidate the clinical course and prognosis in older patients with relapsed or refractory (R/R) DLBCL in a single-center experience in Japan. We conducted a retrospective survey of 52 older patients with R/R DLBCL (aged >65 years at diagnosis; 54% men) who received R-CHOP chemotherapy, to assess their clinical course and prognosis. The median progression-free survival was 8.5 months. Seventeen patients had central nervous system (CNS) relapse, with 11 receiving high-dose methotrexate or whole-brain irradiation. Briefly, 30 patients underwent salvage chemotherapy, whereas 11 received palliative care only. Overall survival (OS) from initial treatment and progression were 20.8 and 7.8 months, respectively. Patients with disease progression within 12 months from initial treatment had a significantly poorer OS than those with disease progression over 12 months, while CNS relapse did not affect OS. Among the 41 reported deaths, 40 were due to lymphoma. As the prognosis in older patients with R/R DLBCL is poor even after salvage chemotherapy, improved initial treatment strategies to reduce the risk of progression and more effective and feasible treatments after progression are warranted.