Retrospective analysis of treatment patterns and outcomes in older adults with diffuse large B-cell lymphoma in the...

Diffuse large B-cell lymphoma (DLBCL) is the most prevalent subtype of non-Hodgkin lymphoma (NHL), accounting for 31% of NHL cases in Western populations with a median diagnosis age of 70.4 years. Despite the efficacy of standard treatments, older patients, particularly those aged 75 years and older, often face under-treatment and poor outcomes. This study examines treatment patterns and outcomes among older adults with DLBCL within the Veterans Health Administration (VHA), which provides a unique opportunity to analyze a cohort of older adults in a large integrated health care system.

Data was analyzed from the VHA and Department of Defense Joint Longitudinal Viewer (JLV). Between January 1, 2011 and December 31, 2021, 6,266 patients were diagnosed with DLBCL. Patients were categorized into four age groups: <65, 65-74, 75-84, and ≥ 85 years. Patients were excluded if they had incomplete demographic, treatment, or survival data within the JLV, or if diagnosis could not be confirmed in structured fields. Chi-squared tests assessed differences among age groups. Overall survival (OS) was analyzed using Kaplan-Meier method and hazard ratios calculated using the Cox Proportional Hazard model.

A total of 3176 patients met inclusion criteria for analysis out of 6266 patients diagnosed with DLBCL between January 1, 2011 and December 31, 2021. Among the included cohort, 33.2% were aged <65, 40.8% aged 65-74, 19.2% aged 75-84, and 6.8% aged ≥85. The median OS was 143 months for <65 years, 72 months for 65-74 years, 43 months for 75-84 years, and 14 months for ≥85 years (p < 0.001). The likelihood of receiving first-line chemotherapy decreased significantly with increasing age, with 30.0% of patients aged 85 years or older receiving no chemotherapy. Among patients who received chemotherapy, completion rates declined with age. Palliative care consultations and hospice enrollment increased with age.

Our findings highlight significant disparities in treatment initiation and completion among older patients with DLBCL. Advanced age negatively impacted survival outcomes. There is an urgent need for tailored treatment approaches and inclusion of geriatric patients in clinical trials to ensure equitable access to innovative therapies. Comprehensive geriatric assessments should guide treatment decisions to enhance outcomes in this vulnerable population.