{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:00:56Z","timestamp":1790006456382,"version":"4.0.1"},"reference-count":20,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/reports9030318","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:12:09Z","timestamp":1789999929000},"page":"318","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chemotherapy-Free Polatuzumab Vedotin and Rituximab (Pola-R) for Frail, Older Patients with Relapsed DLBCL: A Case for Geriatric Assessment and Shared Decision-Making"],"prefix":"10.3390","volume":"9","author":[{"given":"Ryusuke","family":"Horaguchi","sequence":"first","affiliation":[{"name":"Department of Hematology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0961-6253","authenticated-orcid":false,"given":"Shohei","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Hematology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kento","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Hematology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoki","family":"Minemura","sequence":"additional","affiliation":[{"name":"Department of Hematology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsutomu","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Hematology, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ayers, E.C., and Smith, S.M. (2025). Diffuse Large B-Cell Lymphoma in the Older and Frail Patient. Cancers, 17.","DOI":"10.3390\/cancers17050885"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.clml.2024.11.005","article-title":"SOHO State of the Art Updates and Next Questions|Diffuse Large B-Cell Lymphoma in Older Adults: A Comprehensive Review","volume":"25","author":"Iyengar","year":"2025","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_3","first-page":"2566","article-title":"How I Treat Older Patients with DLBCL in the Frontline Setting","volume":"141","author":"Lugtenburg","year":"2023","journal-title":"Blood"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.6004\/jnccn.2021.0043","article-title":"NCCN Clinical Practice Guidelines in Oncology: Older Adult Oncology","volume":"19","author":"Dotan","year":"2021","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103657","DOI":"10.1016\/j.esmoop.2024.103657","article-title":"Adequate assessment yields appropriate care-the role of geriatric assessment and management in older adults with cancer: A position paper from the ESMO\/SIOG Cancer in the Elderly Working Group","volume":"9","author":"Loh","year":"2024","journal-title":"ESMO Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4293","DOI":"10.1200\/JCO.23.00933","article-title":"Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Systemic Cancer Therapy: ASCO Guideline Update","volume":"41","author":"Dale","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"921","DOI":"10.3109\/10428194.2014.953142","article-title":"Comprehensive geriatric assessment is an essential tool to support treatment decisions in elderly patients with diffuse large B-cell lymphoma: A prospective multicenter evaluation in 173 patients by the Lymphoma Italian Foundation (FIL)","volume":"56","author":"Tucci","year":"2015","journal-title":"Leuk. Lymphoma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1200\/JCO.20.02465","article-title":"Simplified Geriatric Assessment in Older Patients With Diffuse Large B-Cell Lymphoma: The Prospective Elderly Project of the Fondazione Italiana Linfomi","volume":"39","author":"Merli","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e6856","DOI":"10.1002\/cam4.6856","article-title":"Validation and modification of simplified Geriatric Assessment and Elderly Prognostic Index: Effective tools for older patients with diffuse large B-cell lymphoma","volume":"13","author":"Yun","year":"2024","journal-title":"Cancer Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.jgo.2020.08.001","article-title":"Shared Decision-Making in Older Patients with Cancer\u2014What Does the Patient Want?","volume":"12","author":"Rostoft","year":"2021","journal-title":"J. Geriatr. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e6291","DOI":"10.1002\/pon.6291","article-title":"Shared decision-making with older adults with cancer: Adaptation of a model through literature review and expert opinion","volume":"33","author":"Gans","year":"2024","journal-title":"Psychooncology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1200\/JCO.19.00172","article-title":"Polatuzumab Vedotin in Relapsed or Refractory Diffuse Large B-Cell Lymphoma","volume":"38","author":"Sehn","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_13","first-page":"1927","article-title":"Rituximab (anti-CD20 monoclonal antibody) for the treatment of patients with relapsing or refractory aggressive lymphoma: A multicenter phase II study","volume":"92","author":"Coiffier","year":"1998","journal-title":"Blood"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1093\/annonc\/mdh176","article-title":"Japanese multicenter phase II and pharmacokinetic study of rituximab in relapsed or refractory patients with aggressive B-cell lymphoma","volume":"15","author":"Tobinai","year":"2004","journal-title":"Ann. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1002\/ajh.70403","article-title":"A Randomized Phase II Study of Subcutaneous Mosunetuzumab in Combination With Polatuzumab Vedotin Compared With Rituximab Plus Polatuzumab Vedotin in Patients With Relapsed or Refractory Large B-Cell Lymphoma","volume":"101","author":"Chavez","year":"2026","journal-title":"Am. J. Hematol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2216","DOI":"10.1182\/blood.2023022048","article-title":"Cell-of-origin effect of polatuzumab vedotin in diffuse large B-cell lymphoma","volume":"142","author":"Cliff","year":"2023","journal-title":"Blood"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1056\/NEJMoa1801445","article-title":"Genetics and Pathogenesis of Diffuse Large B-Cell Lymphoma","volume":"378","author":"Schmitz","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21037\/aol-21-38","article-title":"Primary diffuse large B-cell lymphoma of the central nervous system: Molecular and biological features of neoplastic cells","volume":"6","author":"Bertoni","year":"2022","journal-title":"Ann. Lymphoma"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3799","DOI":"10.1200\/JCO-25-01957","article-title":"Mosunetuzumab Plus Polatuzumab Vedotin in Transplant-Ineligible Refractory\/Relapsed Large B-Cell Lymphoma: Primary Results of the Phase III SUNMO Trial","volume":"43","author":"Budde","year":"2025","journal-title":"J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1056\/NEJMcp074045","article-title":"Clinical Practice. Assessment of Patients\u2019 Competence to Consent to Treatment","volume":"357","author":"Appelbaum","year":"2007","journal-title":"N. Engl. J. 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