Predictors of initial treatment in older adults with follicular non-Hodgkin lymphoma

Abstract

8054 Background: Multiple treatment options are available for patients with follicular lymphoma (FL), including expectant management (EM), radiation therapy (RT), various chemotherapy (CTX) regimens, and immunotherapy (IM). Older age is a well established adverse prognostic factor in FL. Our objective was to identify factors associated with initial treatment in a population-based cohort of older adults with FL. Methods: Using SEER cancer registry data linked with Medicare claims, we identified cases of FL diagnosed in adults age 66 and older from 1995–2002. Initial treatment was defined as EM, CTX alone, RT alone, or combined CTX and RT based on Medicare claims within six months of diagnosis. IM with rituximab was grouped with CTX. We assessed the effects of demographic and clinical characteristics on the odds of receiving each treatment. In patients who initially received EM, we estimated the time until first treatment. Results: In 3,241 FL patients, the most common initial treatment strategy was CTX alone (n=1,351, 42%), followed by EM (n=1,242, 38%), RT alone (n=434, 13%) and combined CTX+RT (n=214, 7%). Treatment varied widely by age ( Table ). In multivariable analysis, predictors of EM included older age at diagnosis (p<0.0001), greater comorbidity (p<0.001) and earlier stage of disease (p<0.01). Use of CTX and RT, each alone or in combination, decreased with increasing age (p<0.0001 for any CTX, p<0.05 for any RT). Later disease stage was positively associated with CTX (p<0.0001) and negatively associated with RT (p<0.0001). Over time, use of CTX increased (p<0.05) and use of RT decreased (p<0.05). About 70% of EM patients remained treatment-free at two years, and the median time until first treatment for this group was 50 months. Conclusions: A substantial fraction of FL patients over age 65 do not receive any cancer-specific treatment at diagnosis, and most of those patients will remain untreated for more than four years. The potential benefits of earlier or more aggressive treatment of these patients remain to be demonstrated. [Table: see text] [Table: see text]