Prognostic Impact of GNRI-IPI Score in Octogenarians with Diffuse Large B- Cell Lymphoma Treated with R-CHOP

Background : Diffuse large B-cell lymphoma (DLBCL) outcomes decline in patients aged ≥ 80 years, with R-CHOP as standard therapy despite frequent dose reductions due to frailty. This study evaluates treatment outcomes and prognostic factors, including the Geriatric Nutritional Risk Index (GNRI), in this population. Methods: We retrospectively analyzed 102 patients aged ≥ 80 years with newly diagnosed DLBCL treated with full-dose or dose-attenuated R-CHOP at Seoul National University Bundang Hospital (2005–2024). Baseline characteristics, treatment delivery, toxicities, and survival were assessed using Kaplan-Meier methods and Cox proportional hazards models. Results: Median age was 83 years; 57.8% had advanced-stage disease, and 55.8% were high/high-intermediate IPI risk. Median relative dose intensity was 54.0%; 65.7% completed treatment. Grade 3–4 toxicities occurred in 33.3%. At 2 years, progression-free survival (PFS) was 67.2%, and overall survival (OS) was 71.8%. In multivariate analysis, low GNRI (< 81.6) independently predicted worse OS (HR 3.09, 95% CI 1.40–6.82, p = 0.005) and PFS (HR 2.84, 95% CI 1.34–6.02, p = 0.006); IPI ≥ 3 was associated with inferior PFS (HR 2.11, 95% CI 1.03–4.32, p = 0.042). The composite GNRI-IPI score stratified OS and PFS effectively, with high-risk showing worse survival (OS: HR 6.44, 95% CI 2.45–16.93, p < 0.001; PFS: HR 6.00, 95% CI 2.42–14.92, p < 0.001) and higher grade 3–4 toxicities (63.6% vs. 22.0% in low-risk, p = 0.023). Conclusions : GNRI-IPI enhances risk stratification and toxicity prediction in very elderly DLBCL patients, supporting nutritional integration in prognostication. Prospective validation is warranted.