Disease characteristics, treatment patterns, prognosis, outcomes and lymphoma‐related mortality in elderly follicular lymphoma in the United States

Nabhan, Chadi; Byrtek, Michelle; Rai, Ashish; Dawson, Keith; Zhou, Xiaolei; Link, Brian K.; Friedberg, Jonathan W.; Zelenetz, Andrew D.; Maurer, Matthew J.; Cerhan, James R.; Flowers, Christopher R.

doi:10.1111/bjh.13399

Cited by 57 publications

(39 citation statements)

References 27 publications

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“…After adjusting for baseline characteristics (including age group), first-line treatment, rituximab dose intensity, and rituximab maintenance in a Cox proportional hazards model (see details in the methods section), a sex difference in favor of females was observed for PFS (HR, 0.84; 95% CI, 0.72–0.97; Table III). The age-by-treatment interaction effect was significant as reported previously [2], but we did not observe a meaningful sex-by-treatment or sex-by-age interaction effect (P > 0.15).…”

Section: Resultssupporting

confidence: 80%

“…While age and racial disparities in FL have been described [2,3], differences in disease presentation and treatment choices between men and women in a large cohort of USA patients have not been adequately described. The prognostic role of sex in outcomes is a mixture.…”

Section: Introductionmentioning

confidence: 99%

“…We further studied variability in overall response rates (ORRs) to similar treatments between men and women and whether OS, PFS and lymphoma-related mortality (LRM) varied by sex among those treated with rituximab-containing regimens. In a previous investigation in FL patients, chemoimmunotherapy improved PFS compared with rituximab monotherapy in patients aged ≤60 years and 61–80 years, but not in those >80 years [2]. Therefore, and given these noted variations based on age, we conducted our analysis of sex differences in the overall cohort and performed subset analyses for specific age groups to account for inherent variability of studied factors that could emerge due to age.…”

Section: Introductionmentioning

confidence: 99%

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Disease, treatment, and outcome differences between men and women with follicular lymphoma in the United States

Nabhan

Zhou

Day³

et al. 2016

American J Hematol

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We aimed to comprehensively study sex differences in disease and patients’ characteristics, treatment and outcomes in patients with follicular lymphoma (FL) in the United States (USA) utilizing the National LymphoCare Study registry (2004–2014). Among evaluable males (n = 1277) and females (n = 1375) with FL, females less commonly received anthracyclines and were more likely to receive rituximab monotherapy. Overall response rates were comparable between sex groups. With a median follow-up of 8.1 years, male sex emerged as an adverse factor for PFS (HR, 0.84, 95% CI, 0.72–0.97). Lymphoma-related mortality (HR, 0.46; 0.23–0.93) and overall survival (HR, 0.63; 0.41–0.97) favored females aged ≤60 years. There are subtle differences in outcomes between male and female FL patients diagnosed and treated in the contemporary era. These data represent the largest prospective analysis of FL patients in the USA based on sex and can aid design of clinical trials for this disease.

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Section: Resultssupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Disease, treatment, and outcome differences between men and women with follicular lymphoma in the United States

Nabhan

Zhou

Day³

et al. 2016

American J Hematol

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“…Similar to other hematologic malignancies [8,12,13]. previous studies suggest that NW patients in the U.S. are managed differently and have inferior outcomes compared with their White counterparts [9].…”

Section: Discussionmentioning

confidence: 76%

Analysis of racial variations in disease characteristics, treatment patterns, and outcomes of patients with chronic lymphocytic leukemia

et al. 2016

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The impact of race on outcomes of patients with chronic lymphocytic leukemia (CLL), the most common leukemia in the west, is not well studied. We aimed to understand racial variations in clinical and disease characteristics, treatment patterns, and outcomes in patients with CLL. We utilized the Mayo Clinic CLL database to perform an analysis of these characteristics and natural history of non-white (NW) compared to white (W) CLL patients. Differences by race in median overall survival (OS) and time-to-first-treatment (TTFT) were investigated. Of the 4215 CLL patients, 4114 (97.6%) were W and 101 (2.4%) were NW. NW patients were younger (median age at diagnosis 59.4 vs. 63.4; P 5 0.003) and more likely to have an elevated LDH (28.0% vs. 16.2%; P 5 0.02). No differences in prognostic parameters were noted. No major differences were observed in treatment selection. OS and TTFT were similar between both groups. In the largest analysis of NW-CLL patients in North America, and contrary to historical retrospective reports, W and NW patients appear to have comparable outcomes when treated similarly. These findings suggest previously noted outcome differences may be due to disparities in access to care and management rather than differences in disease biology.

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“…A history of anemia, poor performance status, and Deyo modification of the Charlson comorbidity index (CCI) were derived from Medicare data using our previous approach. 23,24 …”

Section: Methodsmentioning

confidence: 99%

Assessing the Effectiveness of Treatment Sequences for Older Patients With High-risk Follicular Lymphoma With a Multistate Model

Çaǧlayan

Terawaki

Ayer

et al. 2019

Clinical Lymphoma Myeloma and Leukemia

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Using a large data set, the present survival analysis study assessed the effect of sequential therapies for patients with follicular lymphoma aged ≥ 65 years using a multistate model. We found that rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine in any line of therapy improved overall survival. Background: Disease progression within < 2 years of initial chemoimmunotherapy and patient age > 60 years have been associated with poor overall survival (OS) in follicular lymphoma (FL). No standard treatment exists for these high-risk patients, and the effectiveness of sequential therapies remains unclear. Patients and Methods: We studied the course of FL with first-, second-, and third-line treatment. Using large population-based data, we identified 5234 patients with FL diagnosed in 2000 to 2009. Of these patients, 71% had received second-line therapy < 2 years, and 29% had received no therapy after first-line therapy, with a median OS of < 3 years. Treatment included rituximab, R-CVP (rituximab, cyclophosphamide, vincristine), R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine), R-Other (other rituximab-containing), and other regimens. The Aalen-Johansen estimator and Cox proportional hazards models were used to quantify the outcomes and assess the effects of the clinical and sociodemographic factors. Results: R-CHOP demonstrated the most favorable 5-year OS among first- (71%), second-(55%), and third-line (61%) therapies. First-line R-CHOP improved OS (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.50–0.64) and reduced the mortality risks after first-line (HR, 0.60; 95% CI, 0.47–0.77), second-line (HR, 0.40; 95% CI, 0.29–0.53), and third-line (HR, 0.63; 95% CI, 0.53–0.76) treatments. B-symptoms, being married, and histologic grade 1/2 were associated with the use of earlier second-line therapy. Early progression from second- to third-line therapy was associated with poor OS. The repeated use of R-CHOP or R-CVP as first- and second-line treatment yielded high 2-year mortality rates (R-CHOP + R-CHOP, 17.3%; R-CVP + R-CVP, 21.1%). Conclusion: Our multistate approach assessed the effect of sequential therapy on the immediate and subsequent treatment-line outcomes. We found that R-CHOP in any line improved OS for patients with high-risk FL.

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Disease characteristics, treatment patterns, prognosis, outcomes and lymphoma‐related mortality in elderly follicular lymphoma in the United States

Cited by 57 publications

References 27 publications

Disease, treatment, and outcome differences between men and women with follicular lymphoma in the United States

Disease, treatment, and outcome differences between men and women with follicular lymphoma in the United States

Analysis of racial variations in disease characteristics, treatment patterns, and outcomes of patients with chronic lymphocytic leukemia

Assessing the Effectiveness of Treatment Sequences for Older Patients With High-risk Follicular Lymphoma With a Multistate Model

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