Treatment of diffuse large B-cell lymphoma in the elderly: regimens without anthracyclines are common and not futile

Abstract

Anthracycline-containing regimens (ACRs) are recommended for patients with diffuse large B-cell lymphoma (DLBCL). However, over 40% of elderly patients do not receive ACRs, possibly due to expected toxicities. We characterized treatment choices and compared the 3-year overall survival (OS) rates of 8262 Medicare beneficiaries diagnosed with DLBCL in 2000–2006 identified from the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database. Of the cohort, 45% had ACR with rituximab (ACR-R), 13% had ACR without R, 6% had non-ACR with R (non-ACR-R), 4% had R monotherapy, 3% had non-ACR and 29% had no systemic therapy. Patients not receiving ACR were older and/or had more comorbidities. The unadjusted OS was highest in ACR-R (65%), followed by ACR without R (55%) and non-ACR-R (44%). After adjusting patient covariates, ACR-R showed the best survival (63%). However, OS was comparable between non-ACR-R (52%) and ACR without R (52%). Non-ACR-R could be considered for patients who are poor candidates for ACR.

Keywords::

• Diffuse large B-cell lymphoma
• immunochemotherapy
• survival
• elderly

Acknowledgements

This work was made possible by the University of Iowa Holden Comprehensive Cancer Center Population Research Core which is supported in part by P30 CA086862. This study used the linked SEER–Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute (NCI); the Office of Research, Development and Information, Centers for Medicare & Medicaid Services (CMS); Information Management Services (IMS), Inc.; and the SEER Program tumor registries in creation of the SEER Medicare database.

Potential conflict of interest

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Supplementary material available online

Methods and tables showing codes and further data.