Beyond Chronological Age: Performance Status and Clinical Frailty Predict Survival in Saudi Geriatric Lymphoma Patients: A Competing Risk Analysis

Objective: To evaluate the prognostic impact of performance status, frailty, and treatment intensity on survival outcomes in a geriatric lymphoma cohort using a competing risk framework. In Saudi Arabia, despite a growing aging population, there is a lack of literature detailing frailty or survival dynamics for geriatric lymphoma patients.Methods: We conducted retrospective cohort study in Tertiary center in Riyadh, Saudi Arabia. Geriatric patients (≥ 60 years) diagnosed with lymphoma during 2011–2024 were analyzed. Baseline demographics, laboratory parameters, pathology, and frailty status were extracted. Survival dynamics were modeled using cumulative incidence functions to isolate lymphoma-related mortality (LRM) from age-related competing risks (ACR). Independent predictors of overall survival and time to progression were determined via multivariate Cox proportional hazards regression models.Results: The sample included 139 patients, with a median age of 72 years; 93% had non-Hodgkin lymphoma. The 5-year cumulative incidence of LRM was 35.6%, while ACR was 5%. In multivariate analyses, poor performance status was a dominant independent predictor of death (hazard ratio [HR] = 2.51; p = 0.01); age did not reach statistical significance. Withholding chemotherapy carried a mortality HR of 2.47 (p = 0.08), whereas a reduced-dose strategy protected against competing risks without compromising survival, as compared to full-dose protocols (p = 0.81).Conclusion: Performance status is an independent prognosticator in geriatric lymphoma. Attenuated-dose therapeutic protocols may represent a safe strategy that does not compromise survival.