Alternative regimen for chemotherapy-intolerant lymphoma including practical aspects in Japan

With the increasing number of elderly patients with lymphoma and the emergence of novel agents, clinical investigations for patients considered intolerant to conventional cytotoxic chemotherapy are receiving more focus than before.

This review aims to provide an overview of systemic treatment for patients with lymphoma who are intolerant to conventional chemotherapy, including practical aspects in Japan.

Traditional approaches include dose reduction (e.g. mini-CHOP) or non-anthracycline regimens (e.g. CVP or bendamustine-based regimens) to reduce the risk of cardiotoxicity. A recent trend is the combination of molecular-targeted agents, such as lenalidomide plus rituximab in B-cell lymphoma. However, maintaining durable responses remains a major challenge. In the future, clinical trials in elderly or frail patients are expected to investigate novel agents such as antibody-drug conjugates or bispecific T-cell engagers. In addition, comprehensive geriatric assessment for tailored therapeutic intervention or dose optimization strategies based on individual genomic data is expected in the context of prospective studies.