Diffuse Large B-Cell Lymphoma in Young and Older Patients: Treatment Patterns and Outcomes Based on Data from the Moscow Cancer Registry

Background: Diffuse large B-cell lymphoma (DLBCL) predominantly affects older adults, who often have poorer outcomes compared to younger patients. Real-world data on treatment patterns and age-related prognostic factors remain limited. This study compared treatment patterns and survival outcomes in young and older patients with newly diagnosed DLBCL using the Moscow Cancer Registry. Methods: This retrospective, multicenter observational study included 1,060 patients with newly diagnosed DLBCL, stratified into young (≤65 years; n = 419) and older (>65 years; n = 641) groups. Clinicodemographic characteristics, first-line treatment regimens, and survival outcomes, including progression-free survival (PFS), overall survival (OS), were analyzed. Univariable and multivariable Cox regression analyses were used to identify independent prognostic factors. Results: Older patients more frequently had poor performance status (ECOG ≥2), high International Prognostic Index (IPI) risk, and received reduced-intensity (R-miniCHOP) or anthracycline-free (BR, R-CVP) regimens. Younger patients more often received intensive treatment protocols. At a median follow-up of 24 months, 2-year PFS was 51% in younger patients and 40% in older patients (p = 0.047), while 2-year OS was 77% and 66%, respectively (p < 0.0001). In multivariable analyses, age >65 years was not an independent adverse prognostic factor after accounting for clinical risk factors and tumor immunophenotype. Conclusions: Outcomes were associated with performance status, IPI risk, and tumor immunophenotype, rather than chronological age alone. The use of anthracycline-free regimens was associated with inferior outcomes, likely reflecting baseline comorbidities. These findings underscore the necessity of integrating comprehensive geriatric assessment and molecular profiling into management algorithms for older patients with DLBCL.