The American Society of Clinical Oncology (ASCO) endorses the routine use of comprehensive geriatric assessment, with an emphasis on frailty, to uncover vulnerabilities not discerned in standard clinical evaluations. In elderly patients with lymphoma, dose adjustments of antineoplastic treatments are often made with the aim of mitigating toxicities.

To present two case studies highlighting the use of geriatric assessment in making informed decisions for elderly lymphoma patients.

Patients underwent a standard geriatric assessment in an onco-hematogeriatrics outpatient clinic. The protocol utilized the 10-minute Targeted Geriatric Assessment (10-Taga), assessing social support, health system usage in the past 6 months, falls within the last year, medication count, functionality using the Katz Scale for Basic Activities of Daily Living (ADL), cognition via the 10-Point Cognitive Screener (10-CS), self-perception of health, depressive symptoms using the Geriatric Depression Scale (GDS-4), nutrition based on weight loss over the past year, and gait speed. Each domain contributes 1 point to the assessment.

Two frail patients diagnosed with Hodgkin's lymphoma and Follicular lymphoma were assessed. The first patient, M.J.F, 79 years old, had osteoporosis and sarcopenia. On the Lawton scale, she demonstrated considerable independence for Instrumental Activities of Daily Living (IADL), scoring 26 out of 27. In the 10-TaGA assessment, she scored 0.45 out of 1, categorizing her at medium risk, showcasing no fall history but reduced gait speed and moderate cognitive impairment. The second patient, M.L.G.D, 87 years old, had a pacemaker, aortic valve transplant, hypertension, and type II diabetes mellitus. Her 10-TaGA evaluation showed cognitive impairment, depressive symptoms, nutritional risk, and reduced gait speed. However, she had no fall history, classifying her as medium risk with a score of 0.35 out of 1. When assessed for IADL using the Lawton scale, the patient exhibited no impairment after treatment, marking her as independent with 25 points. The first patient was treated with the Bv-AVD protocol, and the second with the R-CVP protocol. Both had chemotherapy dosages reduced based on their geriatric evaluations. Both achieved complete remission with their respective treatments. The first patient had two hospital admissions due to febrile neutropenia during treatment.

The correlation between frailty and prognosis has been highlighted by various studies. For patients with large B-cell lymphoma, frailty has been linked to a worse prognosis and an increased requirement for dosage reduction or treatment delay due to toxicity. In this report, we detail patients with not only advanced age but also frailty syndrome and declines in geriatric domains. This subgroup appears to be of the highest concern regarding treatment-associated toxicity. Protocols based on biological agents and significant reductions in chemotherapeutic agents were used with relative safety.

Geriatric assessment with specific protocols holds the potential to pinpoint elderly groups at high risk of toxicity during chemotherapy, aiding medical teams in tailoring individualized treatments.