Optimal number of cycles of bendamustine as initial chemoimmunotherapy for older patients with follicular lymphoma

Blood Neoplasia Pub Date : 2024-05-20 DOI:10.1016/j.bneo.2024.100019

Christopher S. Strouse , Vanessa E. Siebert , Bradley T. Loeffler , Bradley D. McDowell , Brian J. Smith , Brian K. Link

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Abstract

Bendamustine is among the most commonly used chemoimmunotherapies for patients with follicular lymphoma (FL). It is typically delivered with a goal regimen consisting of 6 cycles, but it is possible that treatment goals could be achieved with fewer cycles, particularly in older patients. We used data from the National Cancer Institute (NCI) linkage between Surveillance, Epidemiology, and End Results program and Medicare claims to evaluate the overall survival of patients with FL receiving 3 to 4 vs 5 to 6 cycles of bendamustine. Patients receiving 1 to 2 cycles of bendamustine chemotherapy were not included. Patients receiving 5 to 6 cycles of bendamustine were significantly younger (mean age, 75.0 vs 76.2 years; P < .01) and had fewer comorbidities by the NCI comorbidity index (mean score, 1.7 vs 2.0; P = .05) than those receiving 3 to 4 cycles of bendamustine, and on univariate analysis exhibited significantly lower risk of death (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.57-0.98; P = .04). However, multivariate analysis controlling for age and comorbidity did not reveal a significant association between overall survival and number of cycles of bendamustine (HR, 0.87; 95% CI, 0.66-1.15; P = .33). Limitations inherent to use of data such as these for causal inference are acknowledged. Nonetheless, these analyses suggest some older patients with FL achieve satisfactory survival outcomes even with lesser bendamustine exposure, and future efforts to prospectively identify such patients are warranted.

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苯达莫司汀作为老年滤泡性淋巴瘤患者初始化学免疫疗法的最佳周期数

摘要班达莫司汀是滤泡性淋巴瘤（FL）患者最常用的化学免疫疗法之一。该疗法的目标疗程通常为 6 个周期，但也有可能只需较少的周期就能达到治疗目标，尤其是对老年患者而言。我们利用美国国家癌症研究所（NCI）监测、流行病学和最终结果项目与医疗保险报销之间的联系数据，评估了接受 3 至 4 个周期与 5 至 6 个周期苯达莫司汀治疗的 FL 患者的总生存率。接受1至2个周期苯达莫司汀化疗的患者不包括在内。与接受3至4个周期苯达莫司汀化疗的患者相比，接受5至6个周期苯达莫司汀化疗的患者明显更年轻（平均年龄为75.0岁 vs 76.2岁；P <.01），根据NCI合并症指数，合并症也更少（平均得分为1.7分 vs 2.0分；P = .05），单变量分析显示其死亡风险明显更低（危险比[HR]，0.75；95%置信区间[CI]，0.57-0.98；P = .04）。然而，控制年龄和合并症的多变量分析并未显示总生存率与苯达莫司汀周期数之间存在显著关联（HR，0.87；95% CI，0.66-1.15；P = .33）。我们承认使用此类数据进行因果推断存在固有的局限性。尽管如此，这些分析表明，一些年龄较大的 FL 患者即使接触较少的苯达莫司汀也能获得令人满意的生存结果，因此今后有必要对这类患者进行前瞻性鉴别。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Blood Neoplasia

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