Low serum albumin levels and the nongerminal center B-cell subtype according to the Hans algorithm as strong prognostic factors in ≥ 80-year-old patients with large B-cell lymphoma treated with rituximab-containing chemotherapy

Large B-cell lymphoma (LBCL) frequently affects very elderly patients, and treatment decisions for those aged ≥ 80 years are complicated by heterogeneity in frailty. Evidence focusing specifically on prognostic factors in this age group treated with rituximab-containing chemotherapy remains limited. In this study, we retrospectively analyzed 137 patients aged ≥ 80 years with LBCL who received rituximab-based chemotherapy at our institution to identify prognostic factors. The median age was 83 years. Of 137 patients, 51 (37.2%) were > 85 years, and 92 (67.0%) were classified as high-risk by the elderly prognostic index. Cell of origin was determined in 109 patients (79.6%) using the Hans classifier: 46 (33.6%) were germinal center B-cell (GCB) subtype and 63 (46.0%) non-GCB. Median serum albumin at diagnosis was 3.50 g/dL (range, 1.70–4.80). First-line therapies included R-CHOP in 93 patients (67.9%), R-THP-COP in 30 (21.9%), Pola-R-CHP in 4 (2.9%), DA-EPOCH-R in 3 (3.2%), and rituximab monotherapy in 7 (5.1%). The 2-year overall survival (OS) and progression-free survival (PFS) rates were 58.1% and 48.1%, respectively. Multivariate analysis identified four independent adverse prognostic factors for both OS and PFS: age ≥ 85 years (OS HR 2.25, PFS HR 2.11), serum serum albumin < 3.5 g/dL (OS HR 2.25, PFS HR 2.46), non-GCB (OS HR 2.20, PFS HR 2.21) and EPI-high-risk (OS HR 2.83, PFS HR 1.81). In LBCL patients aged ≥ 80 years treated with rituximab-containing chemotherapy, low serum albumin and non-GCB subtype are independent adverse prognostic factors. These accessible indicators should inform treatment eligibility decisions in very elderly patients.