Impact of therapeutic management and geriatric evaluation on patient of eighty years and older with diffuse large B-cell lymphoma on survival: A systematic review.

Background Diffuse large B cell lymphoma (DLBCL) is an aggressive disease. The first-line treatment is well defined in young patients, however in oldest old patients treatment remains unclear. Objectives To investigate the impact of therapeutics management and geriatric evaluation on survival in aged patients with DLBCL. Methods We performed a systematic review of PUBMED and COCHRANE databases of published report on elderly patients (median age 80 and above) with DLBCL, from January 2002 to January 2020. Results We included 32 studies (6 prospective and 26 retrospective). Patients treated with anthracyclines-containing chemoimmunotherapy had a two-years overall survival (OS) of 59% to 74.3% in prospective studies, and 48.1 to 64.6% in retrospective studies. With less intensive treatment without anthracyclines, two-years OS was 28% to 53%. Without specific treatment, median OS was two months. History of falls and severe comorbidities were associated with a decrease survival. Conclusions Chemoimmunotherapy with anthracyclines increase survival in selected very elderly patients in compared to less intensive regimen. Geriatric assessment, in particular altered mobility disorders and severe comorbidities, are predictive of survival and should be associated to the therapeutic decision. More comparative studies are needed to guide the management of frailer patients.