Treating Diffuse Large B Cell Lymphoma in the Very Old or Frail Patients

Abhijeet Kumar, Muhammad Asad Fraz, Muhammad Usman, Saad Ullah Malik, Awais Ijaz, Ceren Durer, Seren Durer, Muhammad Junaid Tariq, Ali Younas Khan, Anum Qureshi, Warda Faridi, Aboo Nasar, Faiz Anwer

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


R-CHOP has been the standard of care for diffuse large B cell lymphoma (DLBCL), curing approximately 60% of patients for more than 2 decades. However, the optimal treatment of patients who are too frail to tolerate this regimen and/or are not candidates for anthracycline therapy continues to be debated. MInT and GELA trials established addition of rituximab to CHOP in DLBCL but excluded patients older than 80 years. Multiple regimens have been tried with varying success in the very elderly, including R-mini-CHOP, R-mini CEOP, R-split CHOP, pre-phase strategies, and R-GCVP. However, there has not been a randomized trial among these strategies. Although addition of novel agents including ibrutinib, brentuximab vedotin, lenalidomide, and many others on the horizon holds promise in this population, none have been tested in a randomized setting or have results awaited. There is also a lack of a validated and easy to use clinical tool in this population to predict patients who will not tolerate R-CHOP. Identifying patients who will not tolerate R-CHOP early with the help of tools like CGA, along with integrating biology-based treatment (ibrutinib, lenalidomide in activated B cell type DLBCL) is being investigated in this population.

Original languageEnglish (US)
Article number50
JournalCurrent Treatment Options in Oncology
Issue number10
StatePublished - Oct 1 2018


  • Chemotherapy
  • Comorbidity
  • Comprehensive geriatric assessment
  • Diffuse large B cell lymphoma
  • Elderly
  • Frail
  • R-CHOP

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)


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