Outcomes of bendamustine- or cyclophosphamide-based first-line chemotherapy in older patients with indolent B-cell lymphoma
Outcomes of bendamustine- or cyclophosphamide-based first-line chemotherapy in older patients with indolent B-cell lymphoma
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DOI：
10.1002/ajh.25707
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发表时间：
2020-01-02
影响因子：
12.8
通讯作者：
Castillo, Jorge J.
中科院分区：
文献类型：
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作者：
Olszewski, Adam J.;Butera, James N.;Castillo, Jorge J.
比较苯达莫司汀/利妥昔单抗（BR）与环磷酰胺为基础的方案（RCHOP/RCVP）的临床试验汇集了各种组织学类型的惰性B细胞淋巴瘤。我们检查了接受这些一线方案治疗的滤泡性（FL）、套细胞（MCL）或边缘区/淋巴浆细胞性淋巴瘤（MZL/LPL）老年患者的实际结局。我们确定了FL，MCL或MZL/LPL的医疗保险受益人，他们在2009-2016年接受了一线BR或RCHOP/RCVP，并使用倾向评分进行了匹配。基于索赔的无事件生存期（EFS），总生存期（OS），毒性，继发性癌症和成本的结果进行了比较，在总队列（N = 2736），并在单独匹配的组织学特异性亚队列。在总体队列中，BR组的EFS优于RCHOP/RCVP组（风险比[HR]，0.78; 95%置信区间[CI]，0.70-0.87）。BR组的急性毒性较低，包括住院率（33% vs 45%）、感染率（21% vs 30%）、心血管事件和输血率，但OS无差异（HR，1.03; 95% CI，0.91-1.17），医疗保险支出较高。继发性癌症的累积发病率无差异（亚危险比，1.11; 95%CI，0.83-1.48）。BR的EFS优势在MCL中明显（N = 690; HR，0.64; 95% CI，0.54-0.76），但在FL中不太明显（N = 1330; HR，0.83; 95% CI，0.69-0.98），在MZL/LPL中不存在（N = 574; HR，0.92; 95% CI，0.73-1.17）。尽管EFS改善且毒性降低，但临床实践中从RCHOP/RCVP转换为BR并未改善老年惰性B细胞淋巴瘤患者的OS。频繁的感染和住院强调了在这一人群中更安全的治疗方法的必要性。与RCHOP/RCVP相比，BR后继发性癌症似乎没有增加。
Clinical trials comparing bendamustine/rituximab (BR) with cyclophosphamide-based regimens (RCHOP/RCVP) have pooled various histologies of indolent B-cell lymphomas. We examined real-life outcomes of older patients with follicular (FL), mantle cell (MCL), or marginal zone/lymphoplasmacytic lymphoma (MZL/LPL), treated with these first-line regimens. We identified Medicare beneficiaries with FL, MCL, or MZL/LPL, who received either first-line BR or RCHOP/RCVP in 2009-2016, and matched groups using a propensity score. Outcomes of claims-based event-free survival (EFS), overall survival (OS), toxicity, secondary cancers, and costs were compared in the aggregate cohort (N = 2736), and in separately matched histology-specific subcohorts. In the aggregate cohort, EFS was better with BR than with RCHOP/RCVP (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.70-0.87). Acute toxicity was lower with BR, including rates of hospitalizations (33% vs 45%), infections (21% vs 30%), cardiovascular events, and transfusions, yet OS did not differ (HR, 1.03; 95% CI, 0.91-1.17) and Medicare spending was higher. There was no difference in the cumulative incidence of secondary cancers (subhazard ratio, 1.11; 95% CI, 0.83-1.48). The EFS advantage of BR was pronounced in MCL (N = 690; HR, 0.64; 95% CI, 0.54-0.76), but less so in FL (N = 1330; HR, 0.83; 95% CI, 0.69-0.98) and absent in MZL/LPL (N = 574; HR, 0.92; 95% CI, 0.73-1.17). Despite improved EFS and lower toxicity, the shift from RCHOP/RCVP to BR in clinical practice did not improve OS for older patients with indolent B-cell lymphomas. Frequent infections and hospitalizations underscore the need for safer treatment approaches in this population. Secondary cancers do not appear to be increased after BR compared with RCHOP/RCVP.