Best supportive care may be most appropriate in a frail patient at this juncture. Outcomes are poor in patients who progress after two or more prior lines of systemic therapy with standard regimens, with the exception of those who experienced a long disease-free interval. Goals of therapy should be discussed with the patient and their caregivers, given the limited value that standard regimens offer.
R-mini-CHOP is used in the first-line setting for very frail patients, but it is not recommended for patients with relapsed/refractory disease. Furthermore, in this case, the patient previously received R-CHOP in the first-line setting. An anti-CD30 monoclonal antibody (brentuximab vedotin) has demonstrated activity in patents with relapsed/refractory DLBCL but is limited to patients with CD-30–positive disease.
While clinical trials with promising novel agents are underway, it is unlikely that an older patient with poor performance status would meet eligibility criteria.
Editor's Note: Skill Checkups are wholly fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.
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Cite this: Zachary Cohn. Skill Checkup: A 74-Year-Old Woman With a History of Treated Diffuse Large B-Cell Lymphoma Has Fatigue and Splenomegaly - Medscape - Mar 30, 2023.