Temporal trends in treatment and survival of older adult diffuse large B-Cell lymphoma patients in the SEER-Medicare linked database

Leuk Lymphoma. 2019 Dec;60(13):3235-3243. doi: 10.1080/10428194.2019.1623886. Epub 2019 Jun 12.

Abstract

To describe temporal trends in treatment among older adult (≥66 years) patients diagnosed with diffuse large B-cell lymphoma (DLBCL), we analyzed 18,058 DLBCL patients from the Surveillance, Epidemiology, and End Results linked Medicare (SEER-Medicare) database diagnosed between 2001 and 2013. Among 65% of patients receiving treatment after diagnosis, R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone) was the most common frontline therapy, increasing with more recent treatment year: 51% (2001-2003) vs. 69% (2010-2014). Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) was uncommon in these Medicare patients. As the addition of rituximab increased over time, we also observed an improved survival rate over time. It is possible there is an association, but we cannot make this inference as effectiveness was not measured in this study. Overall survival estimates indicated that survival probabilities steadily improved in more recent years; however, 5-year survival was <40%, indicating the need for improved treatment options for older adult DLBCL patients.

Keywords: Diffuse large B-cell lymphoma; Medicare; SEER; claims; survival; treatment patterns.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cyclophosphamide / therapeutic use
  • Doxorubicin / therapeutic use
  • Female
  • Hematopoietic Stem Cell Transplantation / statistics & numerical data
  • Hematopoietic Stem Cell Transplantation / trends*
  • Humans
  • Lymphoma, Large B-Cell, Diffuse / mortality
  • Lymphoma, Large B-Cell, Diffuse / therapy*
  • Male
  • Medicare / statistics & numerical data
  • Prednisone / therapeutic use
  • Retrospective Studies
  • Rituximab / therapeutic use
  • SEER Program / statistics & numerical data
  • Survival Rate / trends
  • Time Factors
  • Transplantation, Autologous / statistics & numerical data
  • Transplantation, Autologous / trends
  • Transplantation, Homologous / statistics & numerical data
  • Transplantation, Homologous / trends
  • Treatment Outcome
  • United States / epidemiology
  • Vincristine / therapeutic use

Substances

  • R-CHOP protocol
  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone