title: Treatment of diffuse large B-cell lymphoma in the elderly: regimens without anthracyclines are common and not futile.
abstract: Anthracycline-containing regimens (ACRs) are recommended for patients with diffuse large B-cell lymphoma (DLBCL). However, over 40% of elderly patients do not receive ACRs, possibly due to expected toxicities. We characterized treatment choices and compared the 3-year overall survival (OS) rates of 8262 Medicare beneficiaries diagnosed with DLBCL in 2000-2006 identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Of the cohort, 45% had ACR with rituximab (ACR-R), 13% had ACR without R, 6% had non-ACR with R (non-ACR-R), 4% had R monotherapy, 3% had non-ACR and 29% had no systemic therapy. Patients not receiving ACR were older and/or had more comorbidities. The unadjusted OS was highest in ACR-R (65%), followed by ACR without R (55%) and non-ACR-R (44%). After adjusting patient covariates, ACR-R showed the best survival (63%). However, OS was comparable between non-ACR-R (52%) and ACR without R (52%). Non-ACR-R could be considered for patients who are poor candidates for ACR.
authors.affiliation: Arnold School of Public Health, University of South Carolina.
authors.forename: Yu-Yu
authors.initials: YY
authors.lastname: Tien
authors.forename: Brian K
authors.initials: BK
authors.lastname: Link
authors.forename: John M
authors.initials: JM
authors.lastname: Brooks
authors.forename: Kara
authors.initials: K
authors.lastname: Wright
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chrischilles
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines
keywords: Diffuse large B-cell lymphoma; elderly; immunochemotherapy; survival