Challenges and opportunities in the management of diffuse large B cell lymphoma in older patients.

Challenges and opportunities in the management of diffuse large B cell lymphoma in older patients. Oncologist. 2020 Nov 23;: Authors: Di M, Huntington SF, Olszewski AJ Abstract Most patients with diffuse large B-cell lymphoma (DLBCL) are diagnosed at age 60 or over. Challenges to effective therapy among older individuals include unfavorable biologic features of DLBCL, geriatric vulnerabilities, suboptimal treatment selection, and toxicities of cytotoxic chemotherapy. Wider application of geriatric assessments may help identify fit older patients who benefit from standard immunochemotherapy without unnecessary dose reductions. Conversely, attenuated regimens may provide a better balance of risk and benefit for selected unfit or frail patients. Supportive care with the use of corticosteroid-based prephase, prophylactic growth factors, and early institution of supportive/palliative care can help maximize treatment tolerance. Several novel or emerging therapies have demonstrated favorable toxicity profiles, thus facilitating effective treatment for elderly patients. In the relapsed or refractory setting, patients who are not candidates for stem cell transplantation can benefit from newly approved options including polatuzumab vedotin-based combinations or tafasitamab plus lenalidomide, which may have higher efficacy and/or lower toxicity than historical chemotherapy regimens. Chimeric antigen receptor T-cell therapy has been successfully...
Source: The Oncologist - Category: Cancer & Oncology Authors: Tags: Oncologist Source Type: research