Factors associated with the medical feasibility of completing full-course standard-dose R-CHOP-based therapy in older patients with diffuse large B-cell lymphoma: Development of a clinical risk score

Standard-dose R-CHOP-based therapy remains a cornerstone of first-line treatment for diffuse large B-cell lymphoma (DLBCL), but its medical feasibility varies substantially among older patients. We aimed to identify pretreatment factors associated with medical non-feasibility of completing full-course standard-dose R-CHOP-based therapy and to develop a practical clinical risk score. This single-center retrospective study included 117 patients aged ≥ 60 years with newly diagnosed DLBCL. Medical non-feasibility was defined as inability to initiate or complete the planned course of standard-dose R-CHOP-based therapy for medical reasons. We developed a parsimonious logistic regression model and simplified clinical risk score and internally validated them using 1,000 bootstrap resamples. We explored progression-free survival (PFS) and overall survival (OS) by treatment-feasibility classification. Among 117 patients, 39 (33.3%) were classified as medically non-feasible. Increasing age, ECOG performance status (ECOG-PS) ≥ 2, and lower serum albumin were independently associated with medical non-feasibility. The full model showed good discrimination (AUC, 0.897; optimism-corrected AUC, 0.888), and the simplified score retained comparable performance (AUC, 0.893). In this study, patients in the feasible group had significantly better PFS and OS than those in the non-feasible group (log-rank P < 0.0001 for both). A simple score model based on age, ECOG-PS, and serum albumin may help identify older patients with DLBCL who warrant more comprehensive pretreatment assessment but should not independently guide chemotherapy intensity before external validation.