title: Treatment patterns and comparative effectiveness in elderly diffuse large B-cell lymphoma patients: a surveillance, epidemiology, and end results-medicare analysis.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hamlin
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA sacha@qdresearch.com.
authors.forename: Sacha
authors.initials: S
authors.lastname: Satram-Hoang
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA.
authors.forename: Carolina
authors.initials: C
authors.lastname: Reyes
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA.
authors.forename: Khang Q
authors.initials: KQ
authors.lastname: Hoang
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA.
authors.forename: Sridhar R
authors.initials: SR
authors.lastname: Guduru
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Q.D. Research, Inc., Granite Bay, California, USA; Genentech, Inc., South San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Skettino
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D006278:Medicare; D012189:Retrospective Studies; D000069283:Rituximab; D018426:SEER Program; D014481:United States
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab
keywords: Chemotherapy; Diffuse large B-cell lymphoma; Elderly patients; Survival; Treatment