Approaches for vulnerable and frail older patients with diffuse large B-cell lymphomas.

Abstract

The current review will outline recent data which may improve management of older patients with aggressive lymphoma through comanagement by hematologists and geriatricians. Many recent data show that determinants of prognosis differ in older patients with an increased importance of nonlymphoma-related parameters. As a consequence, geriatric assessment parameters are predictive of the outcome in these patients. Data from clinical trials allow for standardization of chemotherapy in diffuse large B-cell lymphoma even in older fit patients. Yet data are missing in vulnerable and frail patients. Recent results show that anthracyclines appear essential also in vulnerable patients although precautions should be considered. Geriatric intervention will be the next step but its potential value remains to be demonstrated. Although aggressive lymphoma therapy is well standardized, management of vulnerable and frail patients remains complicated because of the accumulation of comorbidities and geriatric syndromes and because they are excluded from clinical trials. Comanagement with hematologists and geriatricians may be the solution to improve outcome but organization of care should reinvented.