Authors: Olszewski AJ, Shafqat H, Ali S
Title: Disparate survival outcomes after front-line chemoimmunotherapy in older patients with follicular, nodal marginal zone and small lymphocytic lymphoma.
Journal: Leuk Lymphoma :1-19
Date: 2014 Jun 23
Abstract: Abstract Using the SEER-Medicare data (1996-2010), we compared survival and toxicity outcomes in 6,993 patients older than 65 years with follicular (FL), nodal marginal zone (NMZL) and small lymphocytic lymphoma (SLL) receiving front-line therapy with rituximab, RCHOP, RCVP or rituximab/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). Analogous associations were evident for cumulative incidence of lymphoma-related death (HR 1.37, P=0.017, and 1.87, P=0.026, respectively). Conversely, in SLL outcomes were similar with any regimen. In NMZL and SLL, survival was not significantly different after single-agent rituximab compared with multi-agent combinations. The choice of front-line chemotherapy may thus impact survival in older patients with indolent lymphomas, and the heterogeneity by histology should be accounted for in clinical trials.
Last Modified: 03 Sep 2013