DLBCL in Older Adults: Is Age Just a Number in LMIC?

Background and objective: Diffuse Large B-cell Lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma in adults. Limited data is available from low middle income countries (LMIC) in patients aged more than 60 years, with DLBCL. Our objective was to determine the presentation, comorbidities, socioeconomic status (SES), treatment received and outcomes of elderly patients with DLBCL.

Subjects and methods: We conducted a multi-centre, retrospective study from 2015 till 2023 and included all adult patients diagnosed with DLBCL. Patients aged more than 60 years were included in the analysis. The variables assessed were age, gender, ECOG status, SES, presenting signs and symptoms, and treatment received. Kaplan Meier curve was plotted for all patients. T-test was used to calculate comparative means and difference in overall survival (p value <0.05). SPSS version 29 was used to perform the analysis.

Results: A total of 652 cases of DLBCL were identified during the study period of which 154 (24%) patients were more than 60 years of age. The median age was 67 years. Male: female ratio was 1.3:1. Approximately 71% of our patients had ECOG performance scores between 2 and 3 and median IPI score of 3. The most common presenting symptoms were fever, weight loss and night sweats and 83% presented with advanced disease. Rituximab+CHOP (RCHOP) regimen was administered to 51% of patients. Relapse of disease was present in 24% who eventually received salvage treatment with either rituximab, ifosfamide, carboplatin, and etoposide (R-ICE), gemcitabine, cisplatin, methylprednisolone (GemP) or dexamethasone, high-dose cytarabine and cisplatin (DHAP). Approximately 65% of patients who received either first line or salvage chemotherapy were not fit enough to undergo consolidation with autologous transplant after achieving remission. In the limited resource group, 55% of patients had a median disease-free survival (DFS) of 0.4 years. In patients with enhanced resources (40%) the DFS was 1.3 years (p value 0.001). The overall survival (OS) was 0.5 years and 1.5 years in limited and enhanced resources group respectively (p value 0.002). Poor survival outcomes were related to multiple comorbidities, inability to give full dose chemotherapy and recurrent infections.

Conclusion: In 80% of the patients the most common presenting symptoms were fever, weight loss and night sweats. RCHOP was administered in approximately 50%. The DFS and OS were decreased in our cohort as compared to international literature. The OS and DFS was better in patients with enhanced as compared to limited resources group. However comorbidities, recurrent infections and poor performance status also contributed to decreased survival. The results suggest that age along with availability of resources play a vital role in management of DLBCL in LMICs.

No relevant conflicts of interest to declare.