ORLANDO, Fla. — Older adults with diffuse large B-cell lymphoma (DLBCL) treated with the frontline chemotherapy regimen known as polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) had similar response rates and survival outcomes compared with younger patients although they had more adverse effects, according to the results of a multicenter retrospective study.

Even a dose-reduced version known as Pola-R-miniCHP used in vulnerable individuals “remained highly effective and did not appear to compromise efficacy in older adults,” reported Varun Iyengar, MD, a fellow with Memorial Sloan Kettering Cancer Center in New York City, and colleagues, at the annual meeting of the American Society of Hematology (ASH) 2025 Annual Meeting.

Pola-R-CHP has become the frontline standard of care based on the 2022 POLARIX study, said Iyengar. However, it excluded patients aged 80 years or older, frailer patients, and those with worse prognosis.

A 2025 report cowritten by Iyengar that quoted federal data, said that the 5-year DLBCL survival is approximately 80% in patients aged 55 years or younger vs approximately 55% in those aged 65 years or older.

Pola-R-CHP in Older Adults

The current study tracked 535 patients from 17 US centers who received frontline pola-R-CHP or pola-R-miniCHP from 2022 to 2025.

Among 210 individuals aged 70 years or older, median age was 75 years vs 62 years in the younger group. The older patients had worse Eastern Cooperative Oncology Group performance status than younger patients (≥ 2 in 23% vs 14%; P < .001) and higher International Prognostic Index scores (3-5 in 77% vs 55%; P < .001).

Median follow-up was 11.8 months.

For the older adults, the overall response rate was 91%, complete response rate was 79%, 1-year progression-free survival was 79%, and 1-year overall survival was 90%. For younger adults, the rates were 93%, 80%, 82%, and 91%, respectively.

Compared with younger adults, the older adults had higher rates of cardiomyopathy (6.2% vs 1.6%; P = .008), grade 3+ neutropenia (38% vs 27%; P = .017), grade 3+ thrombocytopenia (22% vs 11%; P = .002), and hospitalization (38% vs 26%; P = .006). However, rates of neuropathy, infection, and febrile neutropenia in older patients were similar to those in younger patients.

Those who received pola-R-miniCHP didn’t have different response, 1-year progression-free survival, or overall survival rates vs those on the full regimen, Iyengar said.

Patients aged 80 years or older had no difference vs those aged 70-79 years in response rates, 1-year progression-free survival, 1-year overall survival, and toxicity.

‘Very Important Data’

Alvaro Alencar, MD, associate professor of Clinical Medicine and chief medical director at University of Miami Sylvester Comprehensive Cancer Center in Miami, who was not involved with the study, told Medscape Medical News that “this is very important data.”

“There are obviously limitations from retrospective review. However, we do not have data in this population otherwise as they were not included in the [POLARIX] study.”

Alencar added that he often treats older patients with lymphoma with R-mini-CHP-pola, and the study reflects his experience.

He emphasized the importance of frontline success in this population.

“Even though we have many salvage options today, most elderly patients end up not receiving them,” he said. “So the first shot is the best and maybe only shot. This regimen was superior in a randomized phase 3 study and is again here suggesting superiority. It should be the preferred option.”

Regarding cost, Alencar said “the addition of polatuzumab undoubtedly makes the combination more expensive per cycle. But when you look at overall systemwide expenses, the additional expense is counterbalanced by the superior outcomes. So the return on investment is there.”

Iyengar had no disclosures. Some other authors reported various disclosures. Alencar had a relationship with Genentech.