title: Second-line therapy in diffuse large B-cell lymphoma (DLBCL): treatment patterns and outcomes in older patients receiving outpatient chemotherapy.
abstract: Using SEER-Medicare linked data we identified elderly patients diagnosed with diffuse large B-cell lymphoma (DLBCL) between January 2000 and December 2007 who received second-line outpatient chemotherapy for relapsed or refractory disease. Second-line regimens were classified into three mutually exclusive groups: aggressive, conventional, and palliative. Of the 632 (426 relapsed, 206 refractory) patients in the cohort, 27.8% received aggressive second-line therapy, 39.1% received conventional therapy, and 33.1% received palliative therapy. There were no differences in survival by type of therapy received, either for relapsed or refractory patients, although the patient risk profile differed significantly. However, duration of remission, male gender, and anemia at diagnosis were important predictors in relapsed patients, and male gender, B-symptoms, comorbidity burden, and poverty status were important predictors in refractory patients. Survival in elderly patients receiving second-line therapy remains poor, and the 24-month cost of all care exceeds $97,000. Patients would benefit from improved treatment options.
authors.affiliation: a Outcomes Insights, Inc , Westlake Village , CA , USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Danese
authors.affiliation: a Outcomes Insights, Inc , Westlake Village , CA , USA.|b University of Oxford , Oxford , UK.|c Johns Hopkins University School of Medicine , Baltimore , MD , USA.
authors.forename: Robert I
authors.initials: RI
authors.lastname: Griffiths
authors.affiliation: a Outcomes Insights, Inc , Westlake Village , CA , USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Gleeson
authors.affiliation: d AstraZeneca , Gaithersburg , MD , USA.
authors.forename: Tapashi
authors.initials: T
authors.lastname: Dalvi
authors.affiliation: d AstraZeneca , Gaithersburg , MD , USA.
authors.forename: Jingyi
authors.initials: J
authors.lastname: Li
authors.affiliation: e Mayo Clinic Arizona , Scottsdale, AZ , USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Mikhael
authors.affiliation: d AstraZeneca , Gaithersburg , MD , USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Deeter
authors.affiliation: f Klinikum der Universität München , Munich , Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Dreyling
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D019008:Drug Resistance, Neoplasm; D005260:Female; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D019233:Retreatment; D018426:SEER Program; D016896:Treatment Outcome
keywords: Cost; diffuse large B-cell lymphoma; elderly; second-line therapy; survival