Survival and prognostic features of early-stage diffuse large B-cell lymphoma in older adults

Early-stage diffuse large B-cell lymphoma (ESDLBCL) in older adults is understudied, and existing prognostic tools such as the stage-adjusted International Prognostic Index (Sa-IPI) may not adequately account for comorbidity and age-related vulnerability. This study evaluated long-term outcomes and developed a simplified prognostic index for patients aged ≥ 60 years with ESDLBCL.

We retrospectively analyzed adults aged ≥ 60 years with stage I-II DLBCL treated at King Hussein Cancer Center between 2006 and 2023. Survival outcomes were estimated using Kaplan-Meier methods, and prognostic factors were assessed using Cox regression. A prognostic index (KHCC-EPI) incorporating variables independently associated with overall survival (OS) and progression-free survival (PFS) was developed and compared with Sa-IPI using time-dependent ROC curves.

Among 127 patients, median age was 68.4 (range: 60-89 years).The complete response rate was 88%, and 5-year OS and PFS were 70.4% and 67.3%, respectively. Most deaths (58%) were unrelated to lymphoma. ECOG performance status > 1, stage IIE, B symptoms, and Charlson Comorbidity Index (CCI) were independently associated with inferior OS and PFS. The KHCC-EPI stratified patients into distinct risk groups (5-year OS: 95.5% vs 60.5%; p = 0.006) and demonstrated improved discrimination compared with Sa-IPI, particularly when CCI was modelled as a continuous variable.

Older adults with ESDLBCL achieved favourable long-term outcomes, with competing non-lymphoma mortality playing a major role. The KHCC-EPI improves risk stratification beyond Sa-IPI and warrants external validation to guide treatment optimisation in this population.