Outcomes of Diffuse Large B-Cell Lymphoma in Older Adults Treated in Resource-Constrained Settings

Introduction: Treating diffuse large B-cell lymphoma (DLBCL) in elderly patients is challenging. Limited data on elderly DLBCL is available from low- and middle-income countries (LMICs). We analyzed presentations and survival outcomes in patients with DLBCL according to their socioeconomic status. Subjects and Methods: This was a multicenter retrospective study conducted from 2015 to 2023. We included 156 patients aged 60 years or older. The variables examined were age, gender, subtype, resource environment, and treatment received. Kaplan–Meier curves for overall survival (OS) and disease-free survival (DFS) were created for the entire patient cohort. Cox-proportional hazard models were used to adjust for key covariates, e.g., age, ECOG, disease stage, treatment type, and resource setting, with a significance level of p < 0.05. Analysis was performed using SPSS Version 27. Results: The median age was 66 years (60—89 years). Eighty-nine (57%) patients were treated in limited-resource settings, while 43% (n = 67) had enhanced resources. ECOG performance scores between 2 and 3 were present in 71%. The median IPI score was 3. The R-CHOP regimen was administered to 48% (n = 75) of patients, and the CHOP regimen to 29.4% (n = 46) of patients. In 21% (n = 38), salvage treatment was given due to relapsed/refractory disease. None of the patients in this group received consolidation with autologous stem cell transplant. The entire cohort’s OS was 9.8 months, while DFS was 9.4 months. OS (35% vs. 9%; p < 0.001) and DFS (30% vs. 7%; p < 0.001) were better in patients with enhanced resources. The median DFS of patients treated in enhanced settings was 20.7 months versus 9 months in limited resource settings (p < 0.001). Conclusion: Outcomes of elderly patients with DLBCL are suboptimal and can be improved with early referral and the inclusion of rituximab. Enhanced geriatric assessments, along with better supportive care, are essential.