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

Abstract

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Oncology Health Sciences, Epidemiology
Palavra-chave	lymphoma chemoimmunotherapy treatment outcomes
Committee Chair / Thesis Advisor	Goodman, Michael, Emory University
Committee Members	Flowers, Christopher R, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs US (Federal) agency other than CDC

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