Second-line therapy in diffuse large B-cell lymphoma (DLBCL): treatment patterns and outcomes in older patients receiving outpatient chemotherapy

Abstract

Using SEER-Medicare linked data we identified elderly patients diagnosed with diffuse large B-cell lymphoma (DLBCL) between January 2000 and December 2007 who received second-line outpatient chemotherapy for relapsed or refractory disease. Second-line regimens were classified into three mutually exclusive groups: aggressive, conventional, and palliative. Of the 632 (426 relapsed, 206 refractory) patients in the cohort, 27.8% received aggressive second-line therapy, 39.1% received conventional therapy, and 33.1% received palliative therapy. There were no differences in survival by type of therapy received, either for relapsed or refractory patients, although the patient risk profile differed significantly. However, duration of remission, male gender, and anemia at diagnosis were important predictors in relapsed patients, and male gender, B-symptoms, comorbidity burden, and poverty status were important predictors in refractory patients. Survival in elderly patients receiving second-line therapy remains poor, and the 24-month cost of all care exceeds $97,000. Patients would benefit from improved treatment options.

Keywords:

• Cost
• diffuse large B-cell lymphoma
• elderly
• second-line therapy
• survival

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Corrigendum

Acknowledgements

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, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

Funding

Mark Danese, Michelle Gleeson, and Robert Griffiths were employed by Outcomes Insights, Inc at the time this work was completed. Outcomes Insights, Inc. received research funding for this study from Medimmune (now AstraZeneca). Outcomes Insights also receives research and consulting services in the area of hematology from Amgen and Genentech.

Robert Deeter, Jingyi Li, and Tapashi Dalvi were employed by AstraZeneca at the time this study was completed. Astra Zeneca was developing interventions for DLBCL at the time this research was conducted.

Joseph Mikhael and Martin Dreyling received no compensation for their participation in this research. Dr Mikhael receives research funding from Celgene, Onyx, Sanofi and Novartis, unrelated to this project. Dr Dreyling receives research funding and speaker’s honoraria from Roche, unrelated to this project.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at http://dx.doi.org/10.1080/10428194.2016.1228924.