SURVIVAL OUTCOMES AFTER FIRST-LINE THERAPY IN FOLLICULAR LYMPHOMA (FL) USING A UNITED STATES (US) ELECTRONIC MEDICAL RECORD (EMR)-BASED COHORT
(Abstract release date: 05/18/17)
EHA Library. Ogbonnaya A. 05/18/17; 182589; PB1875
Augustina Ogbonnaya
Contributions
Contributions
Abstract
Abstract: PB1875
Type: Publication Only
Background
FL is a heterogeneous disease, and clinical presentation is highly variable. The Follicular Lymphoma International Prognostic Index (FLIPI-2) identifies prognostic factors at diagnosis but does not predict in whom and when to initiate first-line therapy (1LT).1 Recommended therapies for 1LT vary by stage, symptomatology, and tumor burden but include monotherapy with rituximab (R) or in combination with other chemotherapies. Survival of FL patients in the R era has greatly improved, but few studies have evaluated survival outcomes in patients seen in routine clinical care.
Aims
This study aimed to evaluate survival outcomes in a US population of newly diagnosed FL patients seen in routine clinical care.
Methods
A retrospective study was conducted in which the presence of ≥1 inpatient record or ≥2 outpatient records with FL diagnosis codes were used to identified newly diagnosed FL patients from Humedica, a large US EMR database, between 01/01/08 and 07/31/15. The study index date was the first FL record. Patients who subsequently initiated 1LT for FL were followed from the date of treatment initiation until death, loss to follow-up, or end of study (09/30/15) for the evaluation of the survival outcomes. Median progression-free survival (PFS) (defined as initiation of second-line therapy, evidence of supportive care >30 days after the end of a line of therapy, or death), median overall survival (OS), and PFS and OS rates at 2 years following initiation of 1LT were evaluated using Kaplan-Meier analyses.
Results
1,346 newly diagnosed FL patients who initiated 1LT met the patient selection criteria. 47.7% were male, and the mean age was 65.4 years (SD: 12.7). At baseline, 16.6% of patients had a Charlson Comorbidity Index of ≥2, and the most common comorbidities were diabetes (14.5%) and chronic pulmonary disease (11.2%). 1LT consisted of both monotherapy (38.6%) and combination therapy (61.4%). For monotherapy, R was the predominant agent used (85.8%); for combination therapy, bendamustine+R (43.8%) and R-CHOP (24.6%) were the most common. Kaplan-Meier analysis revealed that the 2-year OS and PFS rates (from initiation of 1LT) were 86.9% and 64.6%, respectively. Median OS was not reached, and median PFS was 48.1 months (95% confidence interval: 39.4, 58.4).
Conclusion
The 2-year OS and PFS rates in this newly diagnosed FL patient cohort who received 1LT (the majority of which was R-based) were consistent with expectations in a post-R era. Future analysis will explore the differences clinical characteristics and survival outcomes for patients who received R monotherapy and various R-combination therapies.
Reference: Federico M, et al. J Clin Oncol. 2009;27(27):4555-4562.
Session topic: 19. Indolent Non-Hodgkin lymphoma - Clinical
Keyword(s): Treatment, Survival, Outcome, Follicular lymphoma
Abstract: PB1875
Type: Publication Only
Background
FL is a heterogeneous disease, and clinical presentation is highly variable. The Follicular Lymphoma International Prognostic Index (FLIPI-2) identifies prognostic factors at diagnosis but does not predict in whom and when to initiate first-line therapy (1LT).1 Recommended therapies for 1LT vary by stage, symptomatology, and tumor burden but include monotherapy with rituximab (R) or in combination with other chemotherapies. Survival of FL patients in the R era has greatly improved, but few studies have evaluated survival outcomes in patients seen in routine clinical care.
Aims
This study aimed to evaluate survival outcomes in a US population of newly diagnosed FL patients seen in routine clinical care.
Methods
A retrospective study was conducted in which the presence of ≥1 inpatient record or ≥2 outpatient records with FL diagnosis codes were used to identified newly diagnosed FL patients from Humedica, a large US EMR database, between 01/01/08 and 07/31/15. The study index date was the first FL record. Patients who subsequently initiated 1LT for FL were followed from the date of treatment initiation until death, loss to follow-up, or end of study (09/30/15) for the evaluation of the survival outcomes. Median progression-free survival (PFS) (defined as initiation of second-line therapy, evidence of supportive care >30 days after the end of a line of therapy, or death), median overall survival (OS), and PFS and OS rates at 2 years following initiation of 1LT were evaluated using Kaplan-Meier analyses.
Results
1,346 newly diagnosed FL patients who initiated 1LT met the patient selection criteria. 47.7% were male, and the mean age was 65.4 years (SD: 12.7). At baseline, 16.6% of patients had a Charlson Comorbidity Index of ≥2, and the most common comorbidities were diabetes (14.5%) and chronic pulmonary disease (11.2%). 1LT consisted of both monotherapy (38.6%) and combination therapy (61.4%). For monotherapy, R was the predominant agent used (85.8%); for combination therapy, bendamustine+R (43.8%) and R-CHOP (24.6%) were the most common. Kaplan-Meier analysis revealed that the 2-year OS and PFS rates (from initiation of 1LT) were 86.9% and 64.6%, respectively. Median OS was not reached, and median PFS was 48.1 months (95% confidence interval: 39.4, 58.4).
Conclusion
The 2-year OS and PFS rates in this newly diagnosed FL patient cohort who received 1LT (the majority of which was R-based) were consistent with expectations in a post-R era. Future analysis will explore the differences clinical characteristics and survival outcomes for patients who received R monotherapy and various R-combination therapies.
Reference: Federico M, et al. J Clin Oncol. 2009;27(27):4555-4562.
Session topic: 19. Indolent Non-Hodgkin lymphoma - Clinical
Keyword(s): Treatment, Survival, Outcome, Follicular lymphoma
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