Age is just a number: managing relapsed or refractory diffuse large B-cell lymphoma (DLBCL) in older patients

: Diffuse large B-cell lymphoma (DLBCL) is a disease of older adults, and these patients experience higher rates of relapsed and refractory disease than younger patients. While treatment options in this setting have expanded, this population represents an area of unmet need as they are frequently ineligible for curative or aggressive therapies based on medical comorbidities or functional status, and often excluded from clinical trials. However, it is important to recognize that this is a diverse group of patients, and treatment choices need to be considered on an individual basis. Herein, we discuss an approach to the treatment of older patients with relapsed aggressive lymphoma, including utilization of geriatric assessments to categorize patients based on their fitness. The role of cellular therapy, including autologous stem cell transplant (ASCT) and chimeric antigen receptor T-cell products are reviewed, as well as a discussion of novel, targeted agents available in the relapsed setting with a focus on the available data for older patients for these treatments. For patients who are not fit enough for these therapies, we discuss palliative treatments that are available. We also highlight several emerging classes of drugs that may offer new treatment options in the future and offer our current approach for the management of these patients based on their fitness.