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TREATMENT PATTERNS AND TREATMENT RESPONSE IN PATIENTS WITH FOLLICULAR LYMPHOMA (FL) IN ROUTINE CLINICAL CARE - A UNITED STATES (US) ELECTRONIC MEDICAL RECORD (EMR) DATABASE STUDY
Author(s): ,
Aaron Galaznik
Affiliations:
Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited,Cambridge,United States
,
Jill Bell
Affiliations:
Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited,Cambridge,United States
,
Laurie Hamilton
Affiliations:
Xcenda LLC,Palm Harbor,United States
,
Augustina Ogbonnaya
Affiliations:
Xcenda LLC,Palm Harbor,United States
,
Kristin Hennenfent
Affiliations:
Xcenda LLC,Palm Harbor,United States
,
Michael Eaddy
Affiliations:
Xcenda LLC,Palm Harbor,United States
Yaping Shou
Affiliations:
Xcenda LLC,Palm Harbor,United States
(Abstract release date: 05/18/17) EHA Library. Ogbonnaya A. 05/18/17; 182587; PB1873
Augustina Ogbonnaya
Augustina Ogbonnaya
Contributions
Abstract

Abstract: PB1873

Type: Publication Only

Background
FL represents 70% of all indolent non-Hodgkin lymphomas, and it is widely recognized that FL is a heterogeneous disease, with patients presenting with differing amounts of tumor burden and prognostic indicators. The NCCN guideline recommends using rituximab as a single agent or in combination with other chemotherapies as first-line therapy (1LT) or second-line therapy (2LT). No recommendations are provided beyond 2LT.

Aims
To evaluate treatment patterns and associated response in patients with newly diagnosed FL in routine care in the US.

Methods
Newly diagnosed FL patients aged ≥18 years were selected from Humedica, a large, national US EMR database, between 01/01/08 and 07/31/15 if they had ≥1 inpatient record or ≥2 outpatient records with FL diagnosis codes. The date of the first FL record was the index date. Patients were followed from index until end of continuous activity, progression to diffuse large B-cell lymphoma (DLBCL), death, or end of study period (09/30/15) and were evaluated for FL treatment patterns and treatment response. Possible remission was defined as no additional chemotherapy and no supportive care use or receipt of supportive care <30 days after end of line of therapy (LOT) for <30 days. Lack of remission was defined as receipt of supportive care <30 days after end of LOT for >30 days. Progression was defined as initiation of another LOT, transition to DLBCL, or evidence of supportive care >30 days after end of LOT.

Results

Of the 3,756 patients selected into the study, 1,346 (35.8%) initiated 1LT, and median (interquartile range [IQR]) time to therapy was 1.3 (0.5–5.9) months. Overall, treatment regimens were mainly rituximab-based. In 1LT, more patients initiated combination chemotherapy (61.4%) vs single-agent chemotherapy (38.6%). Bendamustine+rituximab (26.9%) and R-CHOP (15.1%) were the most common combination regimens, and rituximab (33.1%) was the most common single agent. Median (IQR) duration of 1LT was 4.3 (1.7–10.4) months. At the end of 1LT, 54.7% (n=736) had evidence of remission, 25.5% (n=344) progressed, and 1.6% (n=22) had no evidence of remission. Among patients with progression after 1LT, 201 initiated 2LT; 34.3% received a single agent, and 65.7% received combination chemotherapy. 2LT regimens were similar to 1LT, with rituximab (18.9%) remaining the top single agent, while bendamustine+rituximab (25.9%) and R-CHOP (6.0%) remained the top combinations. Median (IQR) duration of 2LT was 3.6 (1.4–6.1) months. Of patients receiving 2LT, 41.3% (n=83) had evidence of remission, 35.4% (n=71) progressed, and 1.5% (n=3) had no evidence of remission. 45 patients who progressed after 2LT received third-line therapy (3LT); 35.6% received a single agent, while 64.4% received combination chemotherapy. In 3LT, rituximab (11.1%) was the most common single agent; bendamustine+rituximab (20.0%) and cyclophosphamide+rituximab+vincristine (8.9%) were the most common combinations. Median (IQR) duration of 3LT was 2.8 (1.4–4.7) months. Following 3LT, 26.7% (n=12) had evidence of remission, 39.9% (n=18) progressed, and 4.4% (n=2) had no evidence of remission.

Conclusion

FL treatment in routine clinical care aligns with treatment guidelines in 1LT and 2LT, with most patients receiving rituximab-based combination chemotherapy. Similar regimens were used in the 3LT setting. As expected, the rates of remission decreased with subsequent LOTs.

Session topic: 19. Indolent Non-Hodgkin lymphoma - Clinical

Keyword(s): Treatment, Outcome, Follicular lymphoma

Abstract: PB1873

Type: Publication Only

Background
FL represents 70% of all indolent non-Hodgkin lymphomas, and it is widely recognized that FL is a heterogeneous disease, with patients presenting with differing amounts of tumor burden and prognostic indicators. The NCCN guideline recommends using rituximab as a single agent or in combination with other chemotherapies as first-line therapy (1LT) or second-line therapy (2LT). No recommendations are provided beyond 2LT.

Aims
To evaluate treatment patterns and associated response in patients with newly diagnosed FL in routine care in the US.

Methods
Newly diagnosed FL patients aged ≥18 years were selected from Humedica, a large, national US EMR database, between 01/01/08 and 07/31/15 if they had ≥1 inpatient record or ≥2 outpatient records with FL diagnosis codes. The date of the first FL record was the index date. Patients were followed from index until end of continuous activity, progression to diffuse large B-cell lymphoma (DLBCL), death, or end of study period (09/30/15) and were evaluated for FL treatment patterns and treatment response. Possible remission was defined as no additional chemotherapy and no supportive care use or receipt of supportive care <30 days after end of line of therapy (LOT) for <30 days. Lack of remission was defined as receipt of supportive care <30 days after end of LOT for >30 days. Progression was defined as initiation of another LOT, transition to DLBCL, or evidence of supportive care >30 days after end of LOT.

Results

Of the 3,756 patients selected into the study, 1,346 (35.8%) initiated 1LT, and median (interquartile range [IQR]) time to therapy was 1.3 (0.5–5.9) months. Overall, treatment regimens were mainly rituximab-based. In 1LT, more patients initiated combination chemotherapy (61.4%) vs single-agent chemotherapy (38.6%). Bendamustine+rituximab (26.9%) and R-CHOP (15.1%) were the most common combination regimens, and rituximab (33.1%) was the most common single agent. Median (IQR) duration of 1LT was 4.3 (1.7–10.4) months. At the end of 1LT, 54.7% (n=736) had evidence of remission, 25.5% (n=344) progressed, and 1.6% (n=22) had no evidence of remission. Among patients with progression after 1LT, 201 initiated 2LT; 34.3% received a single agent, and 65.7% received combination chemotherapy. 2LT regimens were similar to 1LT, with rituximab (18.9%) remaining the top single agent, while bendamustine+rituximab (25.9%) and R-CHOP (6.0%) remained the top combinations. Median (IQR) duration of 2LT was 3.6 (1.4–6.1) months. Of patients receiving 2LT, 41.3% (n=83) had evidence of remission, 35.4% (n=71) progressed, and 1.5% (n=3) had no evidence of remission. 45 patients who progressed after 2LT received third-line therapy (3LT); 35.6% received a single agent, while 64.4% received combination chemotherapy. In 3LT, rituximab (11.1%) was the most common single agent; bendamustine+rituximab (20.0%) and cyclophosphamide+rituximab+vincristine (8.9%) were the most common combinations. Median (IQR) duration of 3LT was 2.8 (1.4–4.7) months. Following 3LT, 26.7% (n=12) had evidence of remission, 39.9% (n=18) progressed, and 4.4% (n=2) had no evidence of remission.

Conclusion

FL treatment in routine clinical care aligns with treatment guidelines in 1LT and 2LT, with most patients receiving rituximab-based combination chemotherapy. Similar regimens were used in the 3LT setting. As expected, the rates of remission decreased with subsequent LOTs.

Session topic: 19. Indolent Non-Hodgkin lymphoma - Clinical

Keyword(s): Treatment, Outcome, Follicular lymphoma

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