Editorial for special research topic: elderly patients and lymphoma

Maria Stefania Infante ^1* José-Ángel Hernández-Rivas ^1,2

• ¹ Hospital Universitario Infanta Leonor, Madrid, Spain
• ² Complutense University of Madrid, Madrid, Madrid, Spain

Lymphoma, particularly among elderly patients, presents unique challenges due to its different subtypes, a complex biology and the intersection of agerelated morbidities with treatment regimens (1). Recent research featured in this special issue highlights significant problems in understanding prognostic factors, therapeutical strategies and novel personalized approaches for elderly patients.Here, we distill key insights from four studies contributing to this growing area of knowledge.The systematic review by Zeng et al. (2) explores the prevalence and the prognostic implications of sarcopenia in hematological malignancies, especially diffuse large B-cell lymphoma (DLBCL) and acute myeloid leukemia (AML). This meta-analysis shows a sarcopenia prevalence of 44.5% with higher rates in older patients. Sarcopenia was associated with significantly poorer overall survival (HR 1.821) and progression-free survival (HR 1.703). These findings suggest incorporation of sarcopenia assessment into prognostic models could optimize therapeutic management to address frailty in older patients. T-cell therapies, making them suitable for frail patients. Consolidation with high dose chemotherapy and autologous HCT remains a viable option in older patients selected based on fitness and disease sensitivity, though its utility is limited by higher toxicity and relapse rates.In conclusion, the studies included in these special issues share important points in managing older patients with lymphoma : the need to achieve a balance between efficacy and safety in those patients, who often cannot tolerate high intensity regimens. The integration of new targeted therapies and the use of a comprehensive geriatric assessment or prognosis score (e.g, ePrognosis) can enhance a personalized approach to elderly patients.As future directions, the findings in these studies highlight crucial gaps and opportunities to improve management of elderly lymphoma patients. Key recommendations include:-Standardized Metrics: Establish universal diagnostic and prognostic criteria, particularly for sarcopenia and molecular markers.-Targeted Therapies: Expand the use of targeted agents with manageable safety profiles, especially in frail patients.-Novel therapies, particularly CAR T-cell treatments, demonstrate comparable outcomes in older adults compared to younger cohorts, underscoring their potential for curative treatment in this age group -Clinical Trials: Prioritize the inclusion of elderly patients in clinical trials to better understand age-specific outcomes.-Multidisciplinary Approaches: Incorporate geriatric assessments, cardio-oncologist, pharmacists, nurses into treatment planning to optimize therapeutic benefits while minimizing risks.