Non-Hodgkin’s lymphoma (NHL) treatment in elderly populations often requires distinct approaches compared to younger patients due to differences in physiology, comorbidities, and tolerance to therapy. While the core principles of treating NHL remain the same—aiming to eradicate or control malignant lymphoid cells—the strategies are adapted to balance efficacy with safety and quality of life in older adults.
Elderly patients frequently present with additional health challenges such as reduced organ function, multiple chronic diseases, and increased vulnerability to treatment side effects. These factors influence treatment decisions, making it essential to individualize therapy rather than applying standard regimens uniformly. For example, the widely used chemotherapy combination R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) remains a cornerstone for many aggressive NHL subtypes, but its intensity and dosing schedules may be modified or replaced with less toxic alternatives in older patients to reduce risks of severe toxicities like myelosuppression, infections, and cardiac complications.
One common approach in elderly NHL patients is dose attenuation or the use of less intensive chemotherapy protocols. This might involve reducing doses, extending intervals between cycles, or substituting certain drugs with agents that have a more favorable side effect profile. For instance, oral palliative chemotherapies containing etoposide have been shown to be well tolerated in elderly patients with aggressive NHL, offering a balance between disease control and manageable toxicity. Such regimens can be particularly valuable for those who are frail or have significant comorbidities that preclude full-dose chemotherapy.
Beyond chemotherapy, targeted therapies and immunotherapies are increasingly important in treating NHL in older adults. These treatments, such as monoclonal antibodies targeting CD20 (rituximab) or novel agents like bispecific antibodies and protein degraders, tend to have more specific mechanisms of action and often fewer systemic side effects than traditional chemotherapy. This specificity can translate into better tolerability for elderly patients, allowing effective disease control with reduced impact on normal tissues. Emerging therapies like glofitamab combined with chemotherapy have demonstrated promising response rates with manageable toxicity profiles, highlighting the potential for integrating novel agents into elderly care plans.
Supportive care is a critical component of managing NHL in the elderly. Because older patients are more susceptible to drug-related problems—including adverse drug reactions, drug-drug interactions, and inappropriate medication use—careful medication review and management are essential. This includes proactive measures to prevent infections, manage chemotherapy-induced nausea and vomiting, and address nutritional and functional status. Tailored supportive interventions can improve treatment adherence and outcomes while minimizing hospitalizations and complications.
In some cases, treatment goals for elderly NHL patients may shift from curative intent to palliation and quality of life preservation. This is especially true for those with limited life expectancy or significant frailty. In such scenarios, less aggressive therapies, symptom control, and psychosocial support become priorities. Decisions are made collaboratively, considering patient preferences, functional status, and overall prognosis.
Overall, treating non-Hodgkin’s lymphoma in elderly populations involves a nuanced balance of maintaining therapeutic effectiveness while minimizing toxicity. Personalized treatment plans that incorporate dose adjustments, novel targeted agents, and comprehensive supportive care are key to optimizing outcomes. As research advances, new therapies with improved safety profiles continue to expand options for older patients, enabling more tailored and effective management of this complex disease.
