Second-line therapy in follicular lymphoma in the United States: Report of NLCS observational study.

Abstract

8049 Background: The National LymphoCare Study (NLCS) collects data on disease presentation, treatment patterns, and clinical outcomes for 2736 patients with with follicular lymphoma diagnosed 2004-2007 in the USA. Patterns of initial management (Rx1) in this cohort were reported previously (Friedberg, JCO 2009). The current report describes patterns of second-line therapy (Rx2). Methods: Data from pts enrolled in NLCS with a diagnosis of FL and active Rx1 were analyzed to establish patterns of Rx2. Therapy after initial period of observation is considered Rx1 for this analysis. Results: Of 2736 pts enrolled, 1841 remain in active follow-up after median 4.9 years and 991 had received Rx2 with median TTRx2 from Rx1 of 11.1 mos. 325 began Rx2 within six months of beginning Rx1, and 521 within a year. Thus far, 252 pts have begun Rx2 > 2 yrs following Rx1. 89% of Rx2 were for progressive disease, 10% toxicity, and 1% both. Seventy-one (7.3%) of the 991 received XRT monotherapy, 62 (6.3%) received therapy as part of a clinical trial and the rest received systemic therapy – most frequently rituximab plus chemotherapy (36.1%, median TTRx2 9.1mos) and rituximab monotherapy (32.4%, median TTRx2 14.1mos). 82 pts received chemotherapy alone, 33 received radioimmunotherapy, and 15 underwent BMT as part of Rx2. Among 461 pts receiving non-investigational chemotherapy, 154 received an anthracycline (median TTRx2 6.4 mos), 270 did not (median TTRx2 9.5mos) and 37 had incomplete data. After Rx2, 61% of pts remained anthracycline naive. Of pts who received investigational therapy as Rx2, 25.8% had received investigational therapy as Rx1, compared to 6.2% for the remaining Rx2 groups. Conclusions: Among the first half of NLCS pts who have received Rx2, a few notable patterns emerge: R-monotherapy is utilized more frequently as Rx2 than as Rx1; rituximab is again utilized frequently as part of Rx2, even when TTRX2 is short, presumably representing rituximab resistance by common definitions; and most pts remain anthracycline naïve. These data give some clarity to the characteristics of pts available for clinical research in the relapsed/refractory setting of FL, although patterns may change as pts who have longer interval to Rx2 are included over time.