Yamasaki Satoshi
Department of Hematology, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume 830-8543, Japan.
Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu 874-0838, Japan.
Hematol Rep. 2024 May 24;16(2):317-330. doi: 10.3390/hematolrep16020032.
Most patients with diffuse large B-cell lymphoma (DLBCL) are >65 years of age, with the number of patients expected to increase in the coming years. A comprehensive geriatric assessment that carefully evaluates fitness status and comorbidities is essential for selecting the appropriate treatment intensity. Although generally healthy patients or those <80 years of age may benefit from standard immunochemotherapy, unfit/frail patients or patients >80 years old may require reduced-intensity chemotherapy or less-toxic drugs. Some new drugs are currently being tested as single or combined agents for first-line treatment, aiming to improve the outcomes of conventional chemotherapy. This review systematically collates and discusses the outcomes associated with the use of immunochemotherapy in older patients with DLBCL, as well as considering the impact of full-dose immunochemotherapy on quality of life in older and frail patients, summarizing the rationale for reduced dosing in the older population, and presenting recommendations for selecting patients likely to benefit from reduced dosing. If preliminary efficacy and safety data are confirmed in future clinical trials, non-chemotherapy-based immunotherapy approaches could become an alternative potentially curative option in frail patients and those >80 years of age with DLBCL.
大多数弥漫性大B细胞淋巴瘤（DLBCL）患者年龄超过65岁，预计未来几年患者数量会增加。全面的老年评估，仔细评估身体状况和合并症，对于选择合适的治疗强度至关重要。虽然一般健康的患者或80岁以下的患者可能从标准免疫化疗中获益，但身体不适/虚弱的患者或80岁以上的患者可能需要降低强度的化疗或毒性较小的药物。目前正在测试一些新药作为一线治疗的单一或联合药物，旨在改善传统化疗的疗效。本综述系统地整理并讨论了老年DLBCL患者使用免疫化疗的相关结果，同时考虑了全剂量免疫化疗对老年和体弱患者生活质量的影响，总结了老年人群减少剂量的理论依据，并提出了选择可能从减少剂量中获益的患者的建议。如果初步疗效和安全性数据在未来临床试验中得到证实，基于非化疗的免疫治疗方法可能成为体弱患者和80岁以上DLBCL患者潜在的治愈性替代选择。
