Diffuse Large B-Cell Lymphoma in Very Elderly Patients at Santa Casa de Sao Paulo, Brazil: A Clinical Analysis in a Single Center

Context: Diffuse large B cell lymphoma (DLBCL) is non-Hodgkin lymphoma\u0027s most common histological subtype. It has a slight predominance in men, around 65 years old median age, but an age-increasing prevalence. Although R-CHOP (rituximab associated to cyclophosphamide, doxorubicin, vincristine and prednisone) is considered its standard treatment, studies generally exclude patients over 80 years old due to their clinical conditions. This results in a lack of scientific data for best therapeutic management to this group of patients. Objective: To evaluate clinical, laboratory and therapeutic profile of DLBCL patients aged equal to or over 80 years old treated at Santa Casa hospital in Sao Paulo, Brazil between January 1, 2013, and December 31, 2017. Design: Retrospective, cross-sectional cohort study of DLBCL patients diagnosed with 80 years old or older treated at Santa Casa hospital in Sao Paulo, Brazil from January 1, 2013 to December 31, 2017. We analyzed their clinical, laboratory and therapeutic data. Patients or other participants: We analyzed 13 patients with DLBCL diagnosed between January,2013 and December 2017. HIV, HBC, and HCV positive serology patients were excluded. Results: We analyzed 13 patients with 83 years old median age, predominantly female (M / F ratio 1.0 / 2.25). More than 90% had some previous comorbidity; cardiovascular and endocrine-metabolic diseases were the most prevalent. At diagnosis, 61.5% had constitutional symptoms and 46.2% had Ann Arbor advanced staging. Concerning laboratory data at diagnosis, 46.2% were anemic, 15.4% were plaquetopenic, 23.1% were lymphopenic and 69.3% were hypoalbuminemic. According to Hans\u0027 criteria, 53,8% were non-GCB DLBCL. In prognostic evaluation according to the R-IPI and NCCN-IPI respectively 46.1% were intermediate-risk and 61.5% high-risk, respectively. R-mini-CHOP was more frequently used for treatment (38.5%) followed by R-CHOP. About 60% of patients who underwent chemotherapy completed treatment initially proposed. The median overall survival (SG) was 118 days and 84.6% died, almost 40% by sepsis. Patients with high serum albumin values and higher hemoglobin values had a statistically significant better OS (p = 0.020). Conclusions: DLBCL in very elderly patients is an orphan clinical situation. It has some relevant characteristics that must be taken into account to offer more adequate and safer therapy.