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Treating Diffuse Large B Cell Lymphoma in the Very Old or Frail Patients

  • Lymphoma (DO Persky, Section Editor)
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Opinion statement

R-CHOP has been the standard of care for diffuse large B cell lymphoma (DLBCL), curing approximately 60% of patients for more than 2 decades. However, the optimal treatment of patients who are too frail to tolerate this regimen and/or are not candidates for anthracycline therapy continues to be debated. MInT and GELA trials established addition of rituximab to CHOP in DLBCL but excluded patients older than 80 years. Multiple regimens have been tried with varying success in the very elderly, including R-mini-CHOP, R-mini CEOP, R-split CHOP, pre-phase strategies, and R-GCVP. However, there has not been a randomized trial among these strategies. Although addition of novel agents including ibrutinib, brentuximab vedotin, lenalidomide, and many others on the horizon holds promise in this population, none have been tested in a randomized setting or have results awaited. There is also a lack of a validated and easy to use clinical tool in this population to predict patients who will not tolerate R-CHOP. Identifying patients who will not tolerate R-CHOP early with the help of tools like CGA, along with integrating biology-based treatment (ibrutinib, lenalidomide in activated B cell type DLBCL) is being investigated in this population.

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Financial disclosure statement

This work was supported in part by grant P30 CA023074 from the National Cancer Institute, National Institutes of Health, and Bethesda, MD.

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Authors and Affiliations

  1. College of Medicine, Hematology/Oncology, University of Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ, 85724, USA

    Abhijeet Kumar MD

  2. Department of Medicine, Hematology/Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, 85724, USA

    Muhammad Asad Fraz MD, Muhammad Usman MD, Saad Ullah Malik MD, Awais Ijaz MD, Ceren Durer MD, Seren Durer MD, Muhammad Junaid Tariq MD, Ali Younas Khan MD, Anum Qureshi MD, Warda Faridi MD & Faiz Anwer MD

  3. Department of Geriatrics, Tri-City Medical Center, 4002 Vista way, Oceanside, CA, 92056, USA

    Aboo Nasar MD

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Correspondence to Abhijeet Kumar MD.

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Conflict of Interest

Abhijeet Kumar declares that he has no conflict of interest.

Muhammad Asad Fraz declares that he has no conflict of interest.

Muhammad Usman declares that he has no conflict of interest.

Saad Ullah Malik declares that he has no conflict of interest.

Awais Ijaz declares that he has no conflict of interest.

Ceren Durer declares that he has no conflict of interest.

Seren Durer declares that he has no conflict of interest.

Muhammad Junaid Tariq declares that he has no conflict of interest.

Ali Younas Khan declares that he has no conflict of interest.

Anum Qureshi declares that he has no conflict of interest.

Warda Faridi declares that he has no conflict of interest.

Aboo Nasar declares that he has no conflict of interest.

Faiz Anwer has received speaker’s honoraria from InCyte and has received compensation from Seattle Genetics for service on an advisory board.

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Kumar, A., Fraz, M.A., Usman, M. et al. Treating Diffuse Large B Cell Lymphoma in the Very Old or Frail Patients. Curr. Treat. Options in Oncol. 19, 50 (2018). https://doi.org/10.1007/s11864-018-0565-6

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