Background: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, with a significant proportion of cases occurring in the elderly. The oldest old (≥85 years) are an underrepresented group in clinical trials, and their outcomes remain poorly characterized. This study examines real-world treatment patterns, outcomes, and safety data for this vulnerable population.

Methods: This retrospective study included patients aged ≥85 years diagnosed with DLBCL and treated at Moffitt Cancer Center from January 2017 to September 2024. Demographic, clinical, and treatment data were collected for 76 patients, and outcomes were analyzed. ECOG score and cumulative illness rating scare geriatric (CIRS-G) was used to assess underlying co-morbidity.

Results: Among 76 patients (51% male), median age 87 years(range- 85 Y -99 Years) , 61 (80.3%) presented with de novo DLBCL. ECOG scores ≥2 were observed in 20 patients (26.3%) remaining 95% had ECOG of (0-2). Median CIRS-G score was 12 (range 4-20) . Germinal center B-cell subtype (GCB) was identified in 40 (52.6%), non-GCB in 28 (36.8%), and unknown in 8 (10.5%). Double hit was present in 9(11.8%). Ann Arbor stage III-IV was noted in 52 (68.4%) pts. B symptoms were present in 25 (32.9%), and extranodal disease occurred in 45 (59.2%). Median LDH was 286 U/L(134-1109 U/L) and IPI > 3 in 62 (81.6%) pts.

First-line (1L) regimens included R-mini-CHOP (50.0%, n=38), R-CHOP (15.8%, n=12), EPOCH-R (6.6%, n=5), Pola-R (6.6%, n=5), and other palliative treatment (21.1%, n=16). Among 51 patients (67.1%) who completed treatment, 34 (66.7%) achieved complete response (CR), 4 (7.8%) had partial response (PR), 2 (3.9%) had stable disease (SD), and 11 (21.6%) experienced progressive disease (PD). CR rates among regimens were: R-Mini-CHOP 19(50%), R-CHOP 3 (23%) , EPOCH-R 3 (75%), Pola –R 5 (100%), others 4 (25%) with no statistical difference in PFS and OS. Lower CIRS-G score (<7) had statistically significant improved OS and PFS. Treatment discontinuation occurred in 25 patients (32.9%) due to toxicity in 11 (44.0%) and PD in 6 (24.0%).

A total of 15 pts (19.7%) developed PD and received treatment. Regimens included R-lenalidomide, R-gemOx, Ibrutinib, and others. Outcomes included CR (33.3%, n=5), PR (20.0%, n=3), and PD (13.3%, n=2). Six pts (7.9%) received 3L therapy, including CAR-T in 1 patient,Pola-R and Tafa-Len in remaining. Radiation therapy was utilized at any point by 10 patients (13.2%). Treatment-related toxicities included neutropenia in 11 patients (14.5%), with 9 (11.8%) experiencing grade 3–4 neutropenia, and infections in 9 patients (11.8%).

Conclusion: The treatment of aged ≥85 years pts with DLBCL remains challenging with increased discontinuations and toxicities. Some patients achieved long term remissions. There is a need to tailor patients with novel approaches such as CAR-T and bispecific antibodies, in order to optimize outcomes. Further research is warranted to refine treatment approaches and expand access to emerging therapies.

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2025
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