Prognostic impact of GNRI-IPI score in octogenarians with diffuse large B-Cell lymphoma treated with R-CHOP

Diffuse large B-cell lymphoma (DLBCL) outcomes decline in patients aged ≥ 80 years, with R-CHOP as standard therapy despite frequent dose reductions due to frailty. This study evaluates treatment outcomes and prognostic factors, including the Geriatric Nutritional Risk Index (GNRI), in this population. We retrospectively analyzed 102 patients aged ≥ 80 years with newly diagnosed DLBCL treated with full-dose or dose-attenuated R-CHOP at Seoul National University Bundang Hospital (2005-2024). Baseline characteristics, treatment delivery, toxicities, and survival were assessed using Kaplan-Meier methods and Cox proportional hazards models. Median age was 83 years; 57.8% had advanced-stage disease, and 55.8% were high/high-intermediate IPI risk. Median relative dose intensity was 54.0%; 65.7% completed treatment. Grade 3-4 toxicities occurred in 33.3%. At 2 years, overall survival (OS) was 71.8% and progression-free survival (PFS) was 67.2%. In multivariate analysis, low GNRI (< 81.6) independently predicted worse OS (HR 3.09, 95% CI 1.40-6.82, p = 0.005) and PFS (HR 2.84, 95% CI 1.34-6.02, p = 0.006); IPI ≥ 3 was associated with inferior PFS (HR 2.11, 95% CI 1.03-4.32, p = 0.042). The composite GNRI-IPI score stratified OS and PFS effectively, with high-risk showing worse survival (OS: HR 6.44, 95% CI 2.45-16.93, p < 0.001; PFS: HR 6.00, 95% CI 2.42-14.92, p < 0.001) and higher grade 3-4 toxicities (63.6% vs. 22.0% in low-risk, p = 0.023). GNRI-IPI enhances risk stratification and toxicity prediction in very elderly DLBCL patients, supporting nutritional integration in prognostication. Prospective validation is warranted.