Open AccessTreatment Patterns and Comparative Effectiveness in Elderly Diffuse Large B‐Cell Lymphoma Patients: A Surveillance, Epidemiology, and End Results‐Medicare Analysis
Author(s) -
Hamlin Paul A.,
SatramHoang Sacha,
Reyes Carolina,
Hoang Khang Q.,
Guduru Sridhar R.,
Skettino Sandra
Publication year - 2014
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2014-0113
Subject(s) - medicine , epidemiology , diffuse large b cell lymphoma , chemotherapy , rituximab , chemoimmunotherapy , proportional hazards model , retrospective cohort study , incidence (geometry) , lymphoma , surgery , physics , optics
Background. The incidence of diffuse large B‐cell lymphoma (DLBCL) occurs disproportionately in elderly patients. We evaluated real‐world treatment patterns and outcomes in elderly DLBCL patients in the U.S. Materials and Methods. A retrospective cohort analysis of 9,333 DLBCL patients from the linked Surveillance, Epidemiology, and End Results (SEER)‐Medicare database was conducted. Patients were diagnosed between January 1, 2000, and December 31, 2007; were aged >66 years, and were continuously enrolled in Medicare Part A and B in the year prior to diagnosis. Within 3 months of diagnosis, 4,565 (49%) received rituximab plus chemotherapy (R+chemo), 2,181 (23%) received chemotherapy only, and 467 (5%) received rituximab monotherapy (R‐mono). Cox proportional hazards regression assessed overall survival between R+chemo versus chemotherapy only and R‐mono versus no treatment. Results. Overall, 23% of patients received no treatment, and the proportion was higher among those aged >80 years (33%). Patients receiving R+chemo were younger and more likely white compared with those receiving chemotherapy only. Patients receiving R‐mono were older and more likely female compared with those not treated. In multivariate analysis, patients receiving chemotherapy only had a twofold increased mortality risk versus R+chemo, and this was confirmed in a subanalysis of patients aged >80 years. A 91% higher mortality risk was noted with receipt of fewer than six cycles versus six cycles of chemotherapy or chemoimmunotherapy. Patients receiving R‐mono had a 69% decreased mortality risk compared with patients who were not treated. Conclusion. This real‐world analysis of elderly DLBCL patients confirmed that 23% do not receive treatment. Overall survival is higher for patients receiving R+chemo and R‐mono relative to chemotherapy only and no treatment, respectively. Suboptimal durations of therapy with curative intent (fewer than six cycles) were associated with poorer outcomes.