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

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.

Keywords: chemotherapy; elderly lymphoma; elderly patients; follicular lymphoma; rituximab.

Fig 1

(A) PFS for FL patients aged >80 years in the NLCS based on their initial treatment strategy. No specific regimen amongst these studied provided these elderly patients with a superior PFS. (B) PFS for FL patients aged >80 years in the NLCS based on anthracycline use. Anthracyclines did not improve PFS in this elderly cohort. (C) OS for patients aged >80 years based on initial treatment selection. No particular regimen improved OS in this elderly cohort. (D) OS for patients aged >80 years based on anthracycline use. Anthracyclines did not improve OS in this elderly cohort. FL, follicular lymphoma; NLCS, National LymphoCare Study; OS, overall survival; PFS, progression-free survival

Fig 2

(A) OS for patients aged >80 years based on FLIPI risk group. Log-rank test for group difference, P = 0·0148. (B) OS for patients aged >80 years based on the new prognostic index of B-symptoms, gender (male) and haemoglobin <120 g/l. Log-rank test for group difference, P < 0·0001. (C) OS for patients aged >80 years in the validation cohort using the SEER-Medicare database. Log-rank test for group difference, P = 0·0072. FLIPI, Follicular Lymphoma International Prognostic Index; OS, overall survival; SEER, Surveillance, Epidemiology and End Results