Outcome of patients older than 80 years with diffuse large B‐cell lymphoma (DLBCL) treated with “standard” immunochemotherapy: A large retrospective study from 4 institutions

Little information is available on the very elderly patients with diffuse large B‐cell lymphoma (DLBCL). We performed a retrospective analysis of 281 patients >80 years old with newly diagnosed DLBCL treated in 4 referral institutions in Switzerland and Northern Italy. Primary end points were overall survival, progression‐free survival, and cause‐specific survival. Systemic chemotherapy was given to 239 patients, and 119 of them received rituximab in their initial treatment. At a median follow‐up of 5.5 years, 5‐year progression‐free survival was 26% (95% confidence interval [CI], 20‐32%), 5‐year overall survival was 31% (95% CI, 25‐37%), and 5‐year cause‐specific survival was 48% (95% CI, 41‐55%) for the entire cohort. Rituximab and/or anthracyclines as part of initial treatment were associated with improved outcome. Cause‐specific survival in patients receiving both agents approximated 60% at 5 years. At multivariate analysis, rituximab use maintained a significant prognostic impact after controlling for age, performance status, stage, haemoglobin, and lactate dehydrogenase levels. The International Prognostic Index as well as the more recently proposed revised‐International Prognostic Index and National Comprehensive Cancer Center Network–International Prognostic Index could discriminate patients with significantly different outcomes. Albeit very elderly and potentially frail, there may be a potential for cure in fit DLBCL patients ≥80 years old. Accurate selection of patients able to tolerate proper immunochemotherapy is crucial.