Danese Mark D, Griffiths Robert I, Gleeson Michelle L, Dalvi Tapashi, Li Jingyi, Mikhael Joseph R, Deeter Robert, Dreyling Martin
a Outcomes Insights, Inc , Westlake Village , CA , USA.
b University of Oxford , Oxford , UK.
Leuk Lymphoma. 2017 May;58(5):1094-1104. doi: 10.1080/10428194.2016.1228924. Epub 2016 Sep 23.
Using SEER-Medicare linked data we identified elderly patients diagnosed with diffuse large B-cell lymphoma (DLBCL) between January 2000 and December 2007 who received second-line outpatient chemotherapy for relapsed or refractory disease. Second-line regimens were classified into three mutually exclusive groups: aggressive, conventional, and palliative. Of the 632 (426 relapsed, 206 refractory) patients in the cohort, 27.8% received aggressive second-line therapy, 39.1% received conventional therapy, and 33.1% received palliative therapy. There were no differences in survival by type of therapy received, either for relapsed or refractory patients, although the patient risk profile differed significantly. However, duration of remission, male gender, and anemia at diagnosis were important predictors in relapsed patients, and male gender, B-symptoms, comorbidity burden, and poverty status were important predictors in refractory patients. Survival in elderly patients receiving second-line therapy remains poor, and the 24-month cost of all care exceeds $97,000. Patients would benefit from improved treatment options.
利用监测、流行病学和最终结果（SEER）医保链接数据，我们确定了2000年1月至2007年12月期间被诊断为弥漫性大B细胞淋巴瘤（DLBCL）且因复发或难治性疾病接受二线门诊化疗的老年患者。二线治疗方案分为三个相互排斥的组：积极型、传统型和姑息型。在该队列的632例患者（426例复发，206例难治）中，27.8%接受了积极的二线治疗，39.1%接受了传统治疗，33.1%接受了姑息治疗。尽管患者的风险特征存在显著差异，但对于复发或难治性患者，接受的治疗类型与生存率并无差异。然而，缓解期、男性性别以及诊断时的贫血是复发患者的重要预测因素，而男性性别、B症状、合并症负担和贫困状况是难治性患者的重要预测因素。接受二线治疗的老年患者生存率仍然很低，所有护理的24个月成本超过97,000美元。患者将从改进的治疗选择中受益。
