Nicholas Madden, MD
No relationships to disclose.
PD 08 - Hematologic 1 - Poster Discussion
Purpose/Objective(s): SWOG 8736 and ECOG 1484 showed improved outcomes with consolidative radiation (RT) for early stage Diffuse Large B Cell Lymphoma (DLBCL) in the pre-rituximab era. Subset analysis from RICOVER-60 and an interim analysis of the UNFOLDER trial indicate patients with high risk features may benefit from RT. A recent phase III trial in non-bulky early stage DLBCL showed RCHOP to be non-inferior to RCHOP followed by RT for 5 year EFS and OS, but only 1/3rd of patients were over 60. Outcomes for older patients, who may not tolerate full courses of chemotherapy, are unclear as these patients are under represented in most of these clinical trials. The Surveillance, Epidemiology, and End Results (SEER) Medicare Database was used to assess the benefit and toxicity of RT after RCHOP in early stage DLBCL in patients over 65.
Materials/Methods: Patients age >65, diagnosed from 1/1999 to 12/2009, Ann Arbor stage I-II, and who received 2-12 cycles of CHOP or R-CHOP with or without RT were identified. RT had to be completed within 180 days of the end of chemotherapy. Propensity score matching was used to compare overall survival of patients with similar stage, age, comorbidity, extranodal involvement, and cycles of chemotherapy.
Results: 1541 patients were identified. Median age was 75. 818 (59.3%) of patients were stage 1. 1206 (78.3%) received RCHOP. 470 (30.5%) received RT. Median number of cycles of chemotherapy received were 4, 3, 6, and 3 for CHOP, CHOP RT, RCHOP and RCHOP RT, respectively. In patients treated with CHOP, RT was associated with improved overall survival on univariate analysis (HR 0.75 (0.56-1.00), p=0.048; 5 year OS 68.7 vs 63.7%). Propensity score matching was not feasible for CHOP vs CHOP RT due to small sample size. When comparing RCHOP and RCHOP RT, RT patients were more likely to have stage I disease (69.8 vs 54.4%, p<0.001), extranodal disease (46.4% vs 39.6%, p=0.031), and receive fewer cycles of chemotherapy (p<0.001), with no difference in age or comorbidity score. RCHOP RT was associated with less febrile neutropenia (p=0.026), thrombocytopenia or neutropenia (p=0.020), and hospitalizations (p<0.001). Using propensity score matching, RT was not associated with improved OS (HR 0.86 (0.65-1.13), p=0.279).
Conclusion: Medicare patients over age 65 who received consolidative RT after RCHOP chemotherapy for DLBCL experienced less febrile neutropenia, thrombocytopenia or neutropenia, and had fewer hospitalizations than patients treated with RCHOP alone. Consolidative RT was associated with equivalent survival. Ongoing clinical trials will further help elucidate which risk factors are indications for consolidative RT, and which patients will benefit from radiation.
No relationships to disclose.
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