Chemotherapy-Free Polatuzumab Vedotin and Rituximab (Pola-R) for Frail, Older Patients with Relapsed DLBCL: A Case for Geriatric Assessment and Shared Decision-Making.

Abstract

Background and Clinical Significance: Older, frail patients with relapsed diffuse large B-cell lymphoma (DLBCL) face limited treatment options due to poor tolerance for standard cytotoxic chemotherapy. While novel chemotherapy-free regimens like polatuzumab vedotin plus rituximab (Pola-R) have emerged, optimizing their use requires careful evaluation of patient vulnerability via geriatric assessment (GA) and shared decision-making (SDM). Case Presentation: We present the case of a male in his late 70s with multiple-relapse DLBCL who was classified as frail by a comprehensive geriatric assessment, complicated by cognitive impairment and functional decline. Due to his frailty and previous intolerance to cytotoxic chemotherapy, a safety-prioritized, chemotherapy-free Pola-R regimen was selected through an SDM process in which his family supported his decision-making. The patient achieved a complete metabolic response without severe adverse events and has remained progression-free for 15 months. Conclusions: This case illustrates the feasibility and potential clinical activity of the chemotherapy-free Pola-R regimen for frail older patients with DLBCL, underscoring the critical role of integrating GA and SDM to individualize therapy and honor patient goals.