How would you approach treatment of a bulky stage II DLBCL in a patient >80 with a contraindication to anthracyclines but otherwise good performance status?

The management of DLBCL in the elderly, particularly those unfit for standard anthracycline-based chemoimmunotherapy, is an area of unmet need and clinical challenges. While there is no single standard of care, and participation in clinical trials designed for this patient population is encouraged, a reasonable consideration would be the R-GCVP regimen (Fields et al, JCO 2014). Practically speaking, many who use this regimen in routine practice may deviate slightly from the published protocol (f...

I also typically use R-GCVP for DLBCL patients with contraindications to anthracyclines. It is well tolerated, however, the day 8 gemcitabine is not always possible. I do not think it has impacted responses skipping the day 8 Gem in my practice.

Another appropriate option for the patients is R-CEOP. The long term follow-up from BCCA has been recently reported and with outcomes almost similar to R-CHOP (Moccia et al., Blood 2021).