Disease Characteristics, Patterns of Care, and Survival in Very Elderly Patients with Diffuse Large B-Cell Lymphoma Open Access

Williams, Jessica (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/pg15bf53w?locale=en


Background: Patients >80 years old have the highest incidence of diffuse large B-cell lymphoma (DLBCL), but are rarely included in DLBCL studies. Although rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered standard therapy for DLBCL, patterns of R-CHOP use and its impact on survival in patients >80 years old are less clear.

Methods: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to characterize presentation, treatment, and survival patterns in elderly DLBCL patients diagnosed from 2004-2009. Chi-squared tests compared characteristics and initial treatments of DLBCL patients >80 years old versus patients aged 66-80 years. Multivariable logistic regression models examined factors associated with treatment selection in patients >80 years old; multivariable Cox proportional hazards models examined the relationship between treatment regimen and survival.

Results: Among 3,513 elderly patients with DLBCL, 922 (26%) were >80 years old. Patients >80 years old were less likely to receive R-CHOP and more likely to be observed or receive cyclophosphamide, vincristine, and prednisone (CVP) with or without rituximab. Marital status, performance status, and disease site were associated with initial receipt of R-CHOP in patients >80 years old. In multivariable Cox proportional hazards models that used observation as the reference category, R-CHOP for >4 cycles was associated with the most favorable overall survival (hazard ratio 0.39; 95% confidence interval 0.28-0.54).

Conclusions: Although DLBCL patients >80 years old were less likely to receive R-CHOP, this regimen conferred the most optimal overall survival and should be considered for this population. Future studies should aim to characterize the impact of DLBCL treatment on quality of life in this age group.

Table of Contents

1. Distribution Agreement

2. Approval Sheet

3. Abstract Cover Page

4. Abstract

5. Cover Page

6. Acknowledgements

7. Thesis. 1-10

8. References. 11-15

9. Table 1. 16-18

10. Table 2. 19

11. Table 3. 20-21

12. Table 4. 22

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