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Br J Haematol. 2015 Jul;170(1):85-95. doi: 10.1111/bjh.13399. Epub 2015 Apr 7.

Disease characteristics, treatment patterns, prognosis, outcomes and lymphoma-related mortality in elderly follicular lymphoma in the United States.

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Department of Medicine Section of Hematology and Oncology, The University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
Genentech Inc, South San Francisco, CA, USA.
Emory University, Atlanta, GA, USA.
RTI Health Solutions, Research Triangle Park, NC, USA.
University of Iowa, Iowa, IA, USA.
University of Rochester, Rochester, NY, USA.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Mayo Clinic, Rochester, MN, USA.


Data from the National LymphoCare Study (a prospective, multicentre registry that enrolled follicular lymphoma (FL) patients from 2004 to 2007) were used to determine disease characteristics, treatment patterns, outcomes and prognosis for elderly FL (eFL) patients. Of 2650 FL patients, 209 (8%) were aged >80 years; these eFL patients more commonly had grade 3 disease, less frequently received chemoimmunotherapy and anthracyclines, and had lower response rates when compared to younger patients. With a median follow-up of 6.9 years, 5-year overall survival (OS) for eFL patients was 59%; 38% of deaths were lymphoma-related. No treatment produced superior OS among eFL patients. In multivariate Cox models, anaemia, B-symptoms and male sex predicted worse OS (P < 0.01); a prognostic index of these factors (0, 1 or ≥ 2 present) predicted OS [hazard ratio (95% CI): ≥ 2 vs. 0, 4.72 (2.38-9.33); 1 vs. 0, 2.63 (1.39-4.98)], with a higher concordance index (0.63) versus the Follicular Lymphoma International Prognostic Index (0.55). The index was validated in an independent cohort. In the largest prospective US-based eFL cohort, no optimal therapy was identified and nearly 40% of deaths were lymphoma-related, representing baseline outcomes in the modern era.


chemotherapy; elderly lymphoma; elderly patients; follicular lymphoma; rituximab

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Conflict of interest statement

Conflict-of-interest disclosures: C.N discloses consulting/advisory board roles for Genentech, Janssen, Celgene, Astellas, and Gilead. M.B discloses employment and stock options with Genentech. J.R.C discloses consulting/advisory roles with Genentech. K.D discloses employment and stock options with Genentech. C.R.F discloses consulting/advisory roles with Algeta, OptumRx, Biogen Idec, Genentech BioOncology, Roche, Celgene and research funding from Abbott, Celgene, Millennium/Takeda, Spectrum, Gilead, and Janssen/Pharmacyclics. J.W.F has no relevant conflict of interests to disclose. B.K.L discloses honoraria from Genentech, consulting and advisory roles with Genentech, AbbVie, Gilead, and research funding from Genentech, Millennium, Pharmacyclics, and Janssen. M.J.M has no relevant conflict of interests to disclose. A.R has no relevant conflict of interests to disclose. A.D.Z discloses consulting /advisory roles with Genentech, Celegene, Gilead, Amgen, Hospira, Reddy Laboratories and research funding from Genentech/Roche, Gilead, and BMS. X.Z is employed by RTI-HS, which has a research contract with Genentech.

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