Survival in elderly follicular lymphoma patients who receive frontline chemo-immunotherapy

Frontline treatment options for patients with follicular lymphoma (FL) include chemotherapy plus rituximab [1]. Randomized clinical trials have demonstrated that rituximab added to frontline CHOP (cyclophosphamide [C], doxorubicin, vincristine [V], and prednisone [P]) or CVP results in improved overall survival in patients with advanced disease [2,3]. However, the impact of rituximab has not been evaluated in routine clinical practice where differences in the treated population and treatment practices could produce differences between trial efficacy and "real-world" effectiveness. In this study, we used data from the Surveillance, Epidemiology, and End Results (SEER)—Medicare database to identify a cohort of 1,117 elderly patients (>66) who received frontline CHOP or CVP, with or without rituximab. The median age was 73, compared to between 52 and 57 in the clinical trials [2,3] depending on the treatment group and trial, and 38% had Stage I/II disease, an exclusion criterion in the trials. In multivariate analysis, we found chemotherapy regimens that included rituximab were associated with lower overall mortality and non-Hodgkin's lymphoma (NHL)—specific mortality, but not mortality due to other causes. Our findings indicate that the survival benefits of rituximab observed in clinical trials translate into benefits for elderly patients in routine clinical practice.