TY - JOUR
T1 - Assessing the Effectiveness of Treatment Sequences for Older Patients With High-risk Follicular Lymphoma With a Multistate Model
AU - Çağlayan, Çağlar
AU - Terawaki, Hiromi
AU - Ayer, Turgay
AU - Goldstein, Jordan S.
AU - Rai, Ashish
AU - Chen, Qiushi
AU - Flowers, Christopher
N1 - Funding Information:
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). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The data were from the Surveillance, Epidemiology, and End Results (SEER)-Medicare and are not owned by the authors of the present study. Data requests will be reviewed by SEER-Medicare and will need to comply with the SEER-Medicare data use agreement. Requests for data should be sent to SEER-Medicare from the US National Cancer Institute webpage or by contacting Elaine Yanisko (Information Management Services, Inc, 3901 Calverton Boulevard, S200, Calverton, MD 20705, or yaniskoe@imsweb.com).
Funding Information:
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 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The data were from the Surveillance, Epidemiology, and End Results (SEER)-Medicare and are not owned by the authors of the present study. Data requests will be reviewed by SEER-Medicare and will need to comply with the SEER-Medicare data use agreement. Requests for data should be sent to SEER-Medicare from the US National Cancer Institute webpage or by contacting Elaine Yanisko (Information Management Services, Inc, 3901 Calverton Boulevard, S200, Calverton, MD 20705, or yaniskoe@imsweb.com ).
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/5
Y1 - 2019/5
N2 - 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.
AB - 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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U2 - 10.1016/j.clml.2018.12.019
DO - 10.1016/j.clml.2018.12.019
M3 - Article
C2 - 30686772
AN - SCOPUS:85060335140
SN - 2152-2669
VL - 19
SP - 300-309.e5
JO - Clinical Lymphoma
JF - Clinical Lymphoma
IS - 5
ER -
