About this item:

24 Views | 0 Downloads

Author Notes:

Çağlar Çağlayan, MS, H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Drive Northwest, Room 321, ISyE Main Building, Atlanta, GA 30332, ccaglayan6@isye.gatech.edu.

The authors have stated that they have no conflicts of interest.

Subjects:

Research Funding:

Research reported in this publication was supported in part by a Burroughs Wellcome Fund Innovation in Regulatory Science Award; and National Cancer Institute award (no. K24CA208132 to C.F. and T32CA160040 to H.T.); and the Winship Research Informatics shared resource, a developing core supported by the Winship Cancer Institute of Emory University (grant P30CA138292).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Hematology
  • Follicular lymphoma
  • High-risk
  • Multistate model
  • Survival prediction
  • Treatment-related mortality
  • RITUXIMAB-REFRACTORY INDOLENT
  • NON-HODGKINS-LYMPHOMA
  • DETUDE DES LYMPHOMES
  • COMPETING RISKS
  • RETROSPECTIVE ANALYSIS
  • 1ST-LINE TREATMENT
  • RANDOMIZED-TRIAL
  • PLUS RITUXIMAB
  • BREAST-CANCER
  • EARLY RELAPSE

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

Tools:

Journal Title:

Clinical Lymphoma, Myeloma and Leukemia

Volume:

Volume 19, Number 5

Publisher:

, Pages 300-+

Type of Work:

Article | Post-print: After Peer Review

Abstract:

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.

Copyright information:

© 2018 Elsevier Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Creative Commons License

Export to EndNote