Arcari Annalisa, Cavallo Federica, Puccini Benedetta, Vallisa Daniele
Hematology and Bone Marrow Transplant Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy.
Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino/Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy.
Front Oncol. 2023 Jul 3;13:1214026. doi: 10.3389/fonc.2023.1214026. eCollection 2023.
Most patients with Diffuse Large B-cell Lymphoma (DLBCL) are old (>65 years of age) and this population is expected to increase in the following years. A simplified geriatric assessment based on a careful evaluation of the fitness status and comorbidities is essential to choose the correct intensity of treatment. Fit older patients can benefit from a standard immunochemotherapy, while unfit/frail patients frequently need reduced doses or substitution of particular agents with less toxic ones. This review focuses on new therapies (e.g., polatuzumab vedotin, tafasitamab, bispecific antibodies) that have indicated promising results in relapsed/refractory patients, particularly in cases not eligible to transplant. Some of these new drugs have been tested as single agents or in combinations as first-line treatment, aiming to improve the outcome of the traditional chemotherapy. If preliminary efficacy and safety data are confirmed in future clinical trials, a chemo-free immunotherapic approach could become an alternative option to offer a curative treatment even in frail patients.
大多数弥漫性大B细胞淋巴瘤（DLBCL）患者年龄较大（>65岁），预计这一人群在未来几年会增加。基于对健康状况和合并症的仔细评估进行简化的老年综合评估对于选择正确的治疗强度至关重要。身体状况良好的老年患者可从标准免疫化疗中获益，而身体状况不佳/虚弱的患者通常需要降低剂量或用毒性较小的特定药物替代。本综述重点关注在复发/难治性患者中显示出有前景结果的新疗法（如泊洛妥珠单抗、tafasitamab、双特异性抗体），特别是在不符合移植条件的病例中。其中一些新药已作为单药或联合用药进行一线治疗测试，旨在改善传统化疗的疗效。如果初步疗效和安全性数据在未来临床试验中得到证实，无化疗的免疫治疗方法可能成为一种替代选择，即使在体弱患者中也能提供治愈性治疗。
