Are oldest old patients with diffuse large B-cell lymphoma different than their younger counterparts: Results from the REALYSA real-life cohort.

Introduction: Over a half of diffuse large B-cell lymphoma (DLBCL) cases are diagnosed in adults aged 65 years and older. Older adults are a heterogeneous group, and few studies reported differences in care management and survival in the oldest old. We aimed to describe characteristics, care management, and survival of older adults aged 60 and over included in the REal-world dAta in LYmphoma and Survival in Adults (REALYSA) study.

Materials: and methods: Patients newly diagnosed with DLBCL, aged over 60 years, included in REALYSA cohort between 2018/11 and 2021/12 and receiving therapy (RCHOP/miniRCHOP/Other) were included. Sociodemographic, living area and clinical characteristics, as well as the type of care center and pathway during the first year after diagnosis were described by age (60-69 y/70-79 y/≥80 y). Survival was described using Kaplan-Meier curves, the Cox model for adjusted survival, and net survival (Pohar-Perme estimator).

Results: A total of 560 DLBCL patients with a median age at diagnosis of 72 years (IQR=67-77) were included. R-CHOP was the main curative treatment in patients aged 60-79, and R-miniCHOP in the oldest old. More than half of the patients were male, married or in a relationship, living in urban and low deprived area. With increasing age, the proportion of patients with performance status 0-1 or no Charlson comorbidity at diagnosis decreased. Two thirds of patients were diagnosed at advanced stage with comparable trends between age groups. However, the oldest patients were more likely to have high-risk disease and geriatric frailty at diagnosis. One-year net survival, in contrast to OS (91 %vs 95 % and 75 % for each age group), showed no significant reduction in survival for 80 + (93 %, 100 % and 87 % for each age group).

Conclusion: As the fastest-growing age group in developed countries, the oldest old require a special attention and further work on this population is needed.