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

• Type of Material: Article
• Authors: Chadi Nabhan, University of Chicago; Michelle Byrtek, Genentech Inc; Ashish Rai, Emory University; Keith Dawson, Genentech Inc; Xiaolei Zhou, RTI Health Solutions; Brian K. Link, University of Iowa; Jonathan W. Friedberg, University of Rochester; Andrew D. Zelenetz, Memorial Sloan Kettering Cancer Center; Matthew J. Maurer, Mayo Clinic; James R. Cerhan, Mayo Clinic; Christopher Flowers, Emory University
• Language: English
• Date: 2015-07-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 John Wiley & Sons Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1111/bjh.13399
• Title of Journal or Parent Work: British Journal of Haematology
• ISSN: 0007-1048
• Volume: 170
• Issue: 1
• Start Page: 85
• End Page: 95
• Grant/Funding Information: This study was funded by Genentech (South San Francisco, CA, USA)/F. Hoffmann-La Roche (Basel, Switzerland). Support for editorial assistance was funded by Genentech.; Grant Support: P30 008748
• Keywords: NATIONAL LYMPHOCARE; INDEX; rituximab; VINCRISTINE; SURVIVAL; Hematology; elderly lymphoma; SEX; Life Sciences & Biomedicine; Science & Technology; elderly patients; CANCER; IMPACT; chemotherapy; CYCLOPHOSPHAMIDE; PREDNISONE; follicular lymphoma
• Research Categories: Health Sciences, Oncology; Health Sciences, Pharmacology

Abstract

Data from the National LymphoCare Study (a prospective, multicentre registry that enrolled follicular lymphoma (FL) patients from 2004 to 2007) were used to determine disease characteristics, treatment patterns, outcomes and prognosis for elderly FL (eFL) patients. Of 2650 FL patients, 209 (8%) were aged >80 years; these eFL patients more commonly had grade 3 disease, less frequently received chemoimmunotherapy and anthracyclines, and had lower response rates when compared to younger patients. With a median follow-up of 6.9 years, 5-year overall survival (OS) for eFL patients was 59%; 38% of deaths were lymphoma-related. No treatment produced superior OS among eFL patients. In multivariate Cox models, anaemia, B-symptoms and male sex predicted worse OS (P < 0·01); a prognostic index of these factors (0, 1 or ≥2 present) predicted OS [hazard ratio (95% CI): ≥2 vs. 0, 4·72 (2·38-9·33); 1 vs. 0, 2·63 (1·39-4·98)], with a higher concordance index (0·63) versus the Follicular Lymphoma International Prognostic Index (0·55). The index was validated in an independent cohort. In the largest prospective US-based eFL cohort, no optimal therapy was identified and nearly 40% of deaths were lymphoma-related, representing baseline outcomes in the modern era.