title: Disparate survival outcomes after front-line chemoimmunotherapy in older patients with follicular, nodal marginal zone and small lymphocytic lymphoma.
abstract: Using Surveillance, Epidemiology and End Results (SEER)-Medicare data (1996-2010), we compared survival and toxicity outcomes in 6993 patients older than 65 years with follicular (FL), nodal marginal zone (NMZL) and small lymphocytic lymphoma (SLL) receiving front-line therapy with rituximab (R), RCHOP (R, cyclophosphamide, doxorubicin, vincristine, prednisone), RCVP (R, cyclophosphamide, vincristine, prednisone) or R-fludarabine-containing regimens within 3 years from diagnosis. We demonstrated significant heterogeneity by histology after various regimens in multivariable survival models. Compared with RCHOP, overall survival was inferior with fludarabine-based regimens in FL (hazard ratio [HR] 1.53, p = 0.0001) and NMZL (HR 1.88, p = 0.0018). Conversely, in SLL outcomes were similar with any regimen. In NMZL and SLL, survival was not significantly different after single-agent R compared with multi-agent combinations. Choice of front-line chemotherapy may thus impact survival in older patients with indolent lymphomas, and heterogeneity by histology should be accounted for in clinical trials.
authors: Division of Hematology-Oncology, Memorial Hospital of Rhode Island , Pawtucket, RI , USA.
authors: Adam J
authors: AJ
authors: Olszewski
authors: Hammad
authors: H
authors: Shafqat
authors: Shihab
authors: S
authors: Ali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D064147:Febrile Neutropenia / Q000139:chemically induced; D005260:Female; D006801:Humans; D007239:Infections / Q000139:chemically induced; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy*; D008224:Lymphoma, Follicular / Q000188:drug therapy*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D000069283:Rituximab / Q000008:administration & dosage / Q000009:adverse effects; D018426:SEER Program / Q000706:statistics & numerical data; D016019:Survival Analysis; D014481:United States; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine; D011241:Prednisone
keywords: Non-Hodgkin lymphoma; chemoimmunotherapy; comparative effectiveness research; nodal marginal zone lymphoma; rituximab