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Summary: Diffuse large B‐cell lymphoma (DLBCL) incidence rises with increasing age. Rituximab‐anthracycline‐based regimens offer a potential cure but also risks of adverse events, especially in the elderly. Using Swedish registers, we conducted a nationwide, population‐based study of DLBCL in the very elderly. We obtained information on clinical characteristics, residence, comorbidity, therapy and survival for the 1194 patients aged ≥80 years diagnosed in Sweden 2007–2014. To address selection bias, we also investigated treatment differences between Sweden's Healthcare Regions and whether there were survival differences between the Regions. The 2‐year overall and relative survivals were better in patients aged ≥80 years given treatment with curative intent (54%; 64%) than low‐intensity (26%; 33%), or palliative treatment (6%; 7%). The fraction of patients treated with curative intent varied between the Healthcare Regions (45–76%). Survival was significantly inferior in Regions with few patients treated with curative intent (multivariable hazard ratio 1.3, 95% confidence interval 1.1–1.6). When treatment intensity and Regions competed, Regions were no longer independent, suggesting that Regional survival differences are due to therapeutic differences. Furthermore, we found that the age‐adjusted International Prognostic Index was independently associated with survival. We conclude that patients aged ≥80 years with DLBCL appear to benefit from rituximab‐anthracycline‐based treatment given with curative intent. [ABSTRACT FROM AUTHOR]

The prognosis of diffuse large B-cell lymphoma (DLBCL) has improved significantly since the introduction of immunochemotherapy (rituximab [R] with cyclophosphamide, doxorubicin, vincristine, prednisone [CHOP]). However, few outcome data are available for very elderly patients (80 years). Therefore, we compared all patients with DLBCL aged 80 years diagnosed in the Gothenburg area during two time periods (2006-2009, 'post-R' and 1997-2000, 'pre-R'). Forty and 30 patients were identified, corresponding to 23.5% and 20.5%, respectively, of the entire population with DLBCL. Estimated 3-year progression-free (PFS) and overall (OS) survival was better post-R than pre-R: 41% vs. 17% ( p == 0.015) and 41% vs. 17% ( p == 0.01), respectively. Fifty-three percent of post-R patients were treated with curative intent with a moderately reduced R-CHOP regimen (median relative dose intensity: 0.86). At a median follow-up of 29 months, the 3-year PFS and OS were 70% ( p == 0.018) and 76% ( p == 0.0089), respectively. In conclusion, moderately reduced R-CHOP is tolerable and effective for a considerable number of very elderly patients with DLBCL and high age by itself should not be a reason for excluding a patient with DLBCL from such treatment. [ABSTRACT FROM AUTHOR]

Objective: The treatment strategy in the very elderly with NSTE-ACS is debated, as they are often under-represented in clinical trials. The aim of this multicenter randomized controlled trial was to compare invasive and conservative strategies in the very elderly with NSTE-ACS. Methods: We randomly assigned patients ≥ 80 years of age with NSTE-ACS to an invasive strategy with coronary angiography and optimal medical treatment or a conservative strategy with only optimal medical treatment. The primary outcome was the combined endpoint of major adverse cardiac and cerebrovascular events (MACCE). Sample size was powered for a 50% reduction of event rate in MACCE with an invasive strategy. We used intention-to-treat analysis. Results: Altogether, 186 patients were included between 2009 and 2017. The study was terminated prematurely due to slow enrollment. At 12-month follow-up, the primary outcome occurred in 31 (33.3%) of the invasive treatment group and 34 (36.6%) of the conservative treatment group, with a hazard ratio (HR) of 0.90 (95% CI 0.55‒1.46; p  = 0.66) for the invasive group relative to the conservative group. The corresponding HR value for urgent revascularization was 0.29 (95% CI 0.10‒0.85; p  = 0.02), 0.56 (95% CI 0.27‒1.18; p  = 0.13) for myocardial infarction, 0.70 (95% CI 0.31‒1.58; p  = 0.40) for all-cause mortality, 1.35 (95% CI 0.23‒7.98; p  = 0.74) for stroke, and 1.62 (95% CI 0.67‒3.90; p  = 0.28) for recurrent hospitalization for cardiac reasons. Conclusion: In the very elderly with NSTE-ACS, we did not find any significant difference in MACCE between invasive and conservative treatment groups at 12-month follow-up, possibly due to small sample size. ClinicalTrials.gov: NCT02126202.