Diffuse large B-cell lymphoma in the elderly: a review of potential difficulties
Cet article passe en revue les difficultés posées par le traitement d'un lymphome diffus à grandes cellules B chez les patients d'âge supérieur à 65 ans
Half of the patients with diffuse large B-cell lymphoma are over 65 years old. These elderly patients frequently have other diseases, some of them severe, which may alter their ability to receive standard curative therapy. However these associated diseases are heterogeneous and only a few contra-indicates chemotherapy treatments. We reviewed all potential difficulties, as the evaluation of comorbidities, the heterogeneous functional status of this population and the consequences of aging process that might be associated with treating these patients and now propose solutions. As standard R-CHOP chemotherapy may cure the majority of patients, it must always be the first proposed option. With this approach elderly patients with DLBCL treated in a curative intent can reach a complete remission and have a similar outcome than younger patients. Reduced dose intensity must be applied for very elderly or unfit patients for full dose anthracycline. The critical question for a physician is why this patient cannot be treated with the standard regimen, namely R-CHOP.