Aggressive B cell lymphomas in elderly patients. Curative or palliative treatment strategy?

Aggressive lymphomas are more frequent in elderly patients and the median age at diagnosis is 64 years. Rational treatment decisions for elderly patients are difficult to make and often influenced by other factors, such as comorbidities and social status as well as experience and preferences of treating physicians. The results of published studies are summarized and discussed in this article. Recommendation for decision-making in this patient collective are presented. This article is based on a PubMed search using the terms aggressive lymphoma, elderly and therapy and on the evaluation of data from the German high-grade non-Hodgkin lymphoma study group. Even in elderly patients with aggressive lymphomas a combined immunochemotherapy including anthracyclines is the only curative treatment approach with a 5-year overall survival of approximately 75 % in fit elderly patients. The decision on whether such a regimen is feasible or a palliative life-extending concept should be selected, can only be made after a prephase therapy for individual patients. In addition, comorbidities and social factors, such as limitations in daily life activities must be incorporated into the treatment plan in this patient population. Geriatric assessments may aid the establishment of rational approaches. The final decision has to be made by the treating physician in close interaction with the patient and relatives.