Age-specific measures for elderly patients with DLBCL
| Measures . |
|---|
| Diagnostic work-up |
| Exclusion/confirmation of EBV-positive DLBCL |
| CNS diagnostics only for patients at high risk for CNS disease or with testicular DLBCL |
| Echocardiogram and lung function test mandatory |
| Exclusion of other relevant organ dysfunctions |
| Determination of performance state only after prephase treatment |
| Prognostic assignation according to classical IPI |
| Patients > 80 y (both chronologically and biologically): |
| Geriatric self-assessement24 |
| Timed up-and-go test, hand-grip test, and Tinetti gait-and-balance test25 |
| Treatment and supportive measures |
| Prephase treatment mandatory |
| CNS prophylaxis with systemic high-dose MTX for patients at high risk for CNS disease only |
| 1 additional rituximab “loading dose” before R-CHOP |
| Not less than 6 × R-CHOP-14 + 2R or 8 × R-CHOP-21 outside clinical trials |
| G-CSF mandatory, preferably pegfilgrastim on day 4 of CHOP |
| Infection prophylaxis with levofloxacin, cotrimoxazole, and aciclovir mandatory |
| Hematogram twice weekly after first R-CHOP |
| Visit approximately day 8 after first R-CHOP |
| Hydrocortisone substitution in patients with fatigue after prednisone tapering |
| No radiotherapy to patients in complete remission after R-CHOP |
| Measures . |
|---|
| Diagnostic work-up |
| Exclusion/confirmation of EBV-positive DLBCL |
| CNS diagnostics only for patients at high risk for CNS disease or with testicular DLBCL |
| Echocardiogram and lung function test mandatory |
| Exclusion of other relevant organ dysfunctions |
| Determination of performance state only after prephase treatment |
| Prognostic assignation according to classical IPI |
| Patients > 80 y (both chronologically and biologically): |
| Geriatric self-assessement24 |
| Timed up-and-go test, hand-grip test, and Tinetti gait-and-balance test25 |
| Treatment and supportive measures |
| Prephase treatment mandatory |
| CNS prophylaxis with systemic high-dose MTX for patients at high risk for CNS disease only |
| 1 additional rituximab “loading dose” before R-CHOP |
| Not less than 6 × R-CHOP-14 + 2R or 8 × R-CHOP-21 outside clinical trials |
| G-CSF mandatory, preferably pegfilgrastim on day 4 of CHOP |
| Infection prophylaxis with levofloxacin, cotrimoxazole, and aciclovir mandatory |
| Hematogram twice weekly after first R-CHOP |
| Visit approximately day 8 after first R-CHOP |
| Hydrocortisone substitution in patients with fatigue after prednisone tapering |
| No radiotherapy to patients in complete remission after R-CHOP |