Background

Rituximab became commercially available in Novermber 1997. It was FDA approved in February 2006 for the first line treatment of patients with advanced diffuse large B cell lymphoma (DLBCL). The incidence of diffuse large B cell lymphoma increases with age, with >100 cases per 100000 persons aged >80 years. There is a limited data on survival very elderly patients with DLBCL. This study was conducted to evaluate survival trends of very elderly (≥80 years) patients with advanced DLBCL in the United States.

Methods

We selected very elderly patients (age ≥80 years) diagnosed with Stage III and IV DLBCL from the Surveillance, Epidemiology, and End Results (SEER) 18 database. We calculated 1- and 2- year relative survival rates of the patients during 1992-1997 (Pre-rituximab era) and 1998-2009 (post –rituximab era). We also analyzed survival rates of patients diagnosed before (1998 – 2005) and after (2006-2009) FDA approval of rituximab for the first line treatment of DLBCL. We used SEER Stat software to calculate relative survival (RS) rates.

Results

There were 2709 advanced DLBCL patients reported during 1992-2009. Overall median survival of the group was 6±0.240 months. The 1- and 2- year relative survival rates of the patients improved significantly from pre-rituximab era to post-rituximab era (1 year RS: 30±2.0 vs 38.9±1.2; Z value 4.16 and 2 year RS: 19.7±1.8 vs 32.8±1.2; Z 5.16). The survival rates were higher in the post-rituximab era for all the cohorts except the Blacks and Others. However, there was no difference in the survival rates of the patients diagnosed during 2006-2009 compared to those diagnosed during 1998-2005 (Table).

Conclusion

Our population based study showed that the survival rates of very elderly patients with advanced DLBCL have improved in the post-rituximab era for all groups except the Blacks and Others. There is no significant improvement in survival of patients before- and after approval of rituximab in the post-rituximab era.

Abstract 2640. Table:

Advanced DLBCL relative survival rates in elderly (age ≥ 80 years)

Cohorts Survival 1992-1997 1998-2009 1998-2005 2006-2009 Z value
(92-97 vs 98-09)		 Zvalue
(98-05 vs 06-09)
NRS ± SE%NRS ± SE%N RS ±SE %NRS ± SE%
Male & Female 12 mo  633 30±2.0 2,076 38.9±1.2  1,274  38.1±1.5  802 40.1±1.9 4.159 0.796 
24 mo 19.7±1.8 2,076 32.8±1.2  31.2±1.5 35.3±1.9 5.162 1.166 
Male 12 mo  263 30.6±3.1 950 39.7±1.7  583  38.3±2.2  367 41.0±2.8 2.798 0.632 
24 mo 18.6±2.7 950 33.7±1.8  30.6±2.2 38.4±3.0 3.750 1.304 
Female 12 mo  370 29.5±2.5 1,126 38.2±1.5  691  37.4±2.0  435 39.4±2.5 3.036 0.478 
24 mo 20.4±2.3 1,126 32.1±1.6  31.7±2.0 32.7±2.5 3.620 0.335 
White 12 mo  572 29.8±2.0 1,786 39.8±1.3  1,101  38.5±1.6  685 41.8±2.0 4.145 1.106 
24 mo 19.9±1.9 1,786 33.7±1.3  32.0±1.6 36.4±2.1 5.029 1.266 
Black 12 mo  20 21.0±9.4 77 27.0±5.4  46  30.9±7.3  31 21.2±7.8 1.499 -1.030 
24 mo 17.3±9.2 77 23.6±5.5  25.1±7.0 19.5±8.0 1.476 -0.894 
Other 12 mo  41 36.1±7.8 211 35.4±3.5  126  36.3±4.5  85 34.1±5.4 0.349 0.029 
24 mo 16.7±6.3 211 28.1±3.4  25.4±4.1 31.7±5.4 1.114 0.631 
Cohorts Survival 1992-1997 1998-2009 1998-2005 2006-2009 Z value
(92-97 vs 98-09)		 Zvalue
(98-05 vs 06-09)
NRS ± SE%NRS ± SE%N RS ±SE %NRS ± SE%
Male & Female 12 mo  633 30±2.0 2,076 38.9±1.2  1,274  38.1±1.5  802 40.1±1.9 4.159 0.796 
24 mo 19.7±1.8 2,076 32.8±1.2  31.2±1.5 35.3±1.9 5.162 1.166 
Male 12 mo  263 30.6±3.1 950 39.7±1.7  583  38.3±2.2  367 41.0±2.8 2.798 0.632 
24 mo 18.6±2.7 950 33.7±1.8  30.6±2.2 38.4±3.0 3.750 1.304 
Female 12 mo  370 29.5±2.5 1,126 38.2±1.5  691  37.4±2.0  435 39.4±2.5 3.036 0.478 
24 mo 20.4±2.3 1,126 32.1±1.6  31.7±2.0 32.7±2.5 3.620 0.335 
White 12 mo  572 29.8±2.0 1,786 39.8±1.3  1,101  38.5±1.6  685 41.8±2.0 4.145 1.106 
24 mo 19.9±1.9 1,786 33.7±1.3  32.0±1.6 36.4±2.1 5.029 1.266 
Black 12 mo  20 21.0±9.4 77 27.0±5.4  46  30.9±7.3  31 21.2±7.8 1.499 -1.030 
24 mo 17.3±9.2 77 23.6±5.5  25.1±7.0 19.5±8.0 1.476 -0.894 
Other 12 mo  41 36.1±7.8 211 35.4±3.5  126  36.3±4.5  85 34.1±5.4 0.349 0.029 
24 mo 16.7±6.3 211 28.1±3.4  25.4±4.1 31.7±5.4 1.114 0.631 
View Large

N: Number of patients

Disclosures

No relevant conflicts of interest to declare.

Topics:
diffuse large b-cell lymphoma, ecological study, older adult, rituximab, software

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2014 by The American Society of Hematology
2014
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