A population‐based multistate model for diffuse large B‐cell lymphoma‐specific mortality in older patients

Background

Despite effective therapies, outcomes for diffuse large B‐cell lymphoma (DLCBL) remain heterogeneous in older individuals due to comorbid diseases and variations in disease biology.

Methods

Using the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database, the authors conducted a multistate survival analysis of 11,780 patients with DLBCL who were aged ≥65 years at the time of diagnosis (2002‐2009). Cox proportional hazards models were used to specify the impact of prognostic factors on overall survival and cause‐specific deaths, and the Aalen‐Johansen estimator was used to project the course of DLBCL over time with or without standard therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP).

Results

Advanced age (hazard ratio [HR] for ages 71‐75 years: 1.25; HR for ages 76‐80 years: 1.46; HR for ages 81‐85 years: 1.88; and HR for age ≥86 years: 2.26), DLBCL stage (HR for Ann Arbor stage II: 1.28; HR for stage III: 1.54; and HR for stage IV: 1.95), Charlson Comorbidity Index (CCI) ≥1 (HR for CCI of 1, 1.15; and HR for CCI >1, 1.37), and not being married (HR, 1.12) were associated with an increased risk of DLBCL‐specific death. Being female (HR, 0.91) and of higher socioeconomic status (HR, 0.91) were associated with a lower risk of DLBCL‐related mortality after therapy. For patients treated with R‐CHOP (3610 patients), the risk of death due to DLBCL was 14.0% and 18.6%, respectively, at 2 and 5 years of treatment and plateaued afterward, confirming a 5‐year "cure" point while receiving R‐CHOP among older patients.

Conclusions

Conducting a survival analysis over a large data set, the current study evaluated competing risks for death within a multistate modeling framework, and identified age, sex, and CCI as risk factors for DLBCL‐specific and other causes of death.

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