title: Treatment of the elderly patient with diffuse large B cell lymphoma.
abstract: The majority of patients with diffuse large B-cell lymphoma are over the age of 60 years and the management of these patients is often sub-optimal. Intensive therapy with curative intent should be given to all patients who can tolerate such therapy, and this requires very careful evaluation of each patient prior to treatment allocation. A detailed history and examination are required, with attention to concomitant disease and existing drug therapy. A quantitative assessment of comorbidity and a comprehensive geriatric assessment (CGA) are valuable adjuncts to physician judgment. For most elderly patients, the R-CHOP regimen (rituximab, cyclophosphamide doxorubicin, vincristine, prednisolone) remains the standard of care. Granulocyte colony-stimulating factor should be given routinely. Reassessment before each cycle of therapy is essential and interim echocardiography should be performed. In patients with cardiac insufficiency there are a number of alternative regimens but no definitive 'best regimen.' In those patients not treated with curative intent a multi-disciplinary approach is essential.
authors.affiliation: Department of Haematology GSST, Kings Health Partners, London, UK. paul.fields@gstt.nhs.uk
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fields
authors.forename: David C
authors.initials: DC
authors.lastname: Linch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone