How I treat older patients with relapsed/refractory diffuse large B-cell lymphoma

Abstract

Diffuse large B-cell lymphoma (DLBCL) is an aggressive, yet curable, malignancy, but older patients are at higher risk of relapsed disease because they may not be eligible for full-intensity frontline chemoimmunotherapy or have comorbidities that limit standard treatments. Recent years have brought more treatment options than ever for this patient population, but it remains challenging to determine which can be safely and effectively offered to older patients. Formal determinations of fitness including geriatric assessments remain critical, but there is less guidance on how to best use this tool in the relapsed setting. Chimeric antigen receptor T-cell therapy is accessible to older patients, provided they can be supported through the intensive road to this treatment. If relapse occurs despite this or alternative therapies are preferred, many novel therapeutic options and combinations exist with some potential modifications for older adults, such as bispecific antibodies, tafasitamab and lenalidomide, polatuzumab-containing regimens, or loncastuximab tesirine. This article provides a summary of our approach to the management of this diverse population of older patients with relapsed or refractory DLBCL.

Graphical abstract

Figure 1.

Our approach to the older patient with R/R DLBCL who is interested in cellular therapy. CR, complete response; PR, partial response; SD, stable disease. Professional illustration by Patrick Lane, ScEYEnce Studios.

Figure 2.

Our approach to the older patient with R/R DLBCL after CAR T-cell therapy or who is ineligible for or uninterested in CAR T-cell therapy in the absence of a clinical trial. Glofit, glofitamab. Professional illustration by Patrick Lane, ScEYEnce Studios.