Outcomes of older patients with follicular lymphoma using individual data from 5922 patients in 18 randomized controlled trials

• Published in: Blood advances 2021-03, Vol.5 (6), p.1737-1745
• Main Authors: Casulo, Carla, Dixon, Jesse G., Ou, Fang-Shu, Hoster, Eva, Peterson, Bruce A., Hochster, Howard S., Brice, Pauline, Ladetto, Marco, Hiddemann, Wolfgang, Marcus, Robert, Kimby, Eva, Herold, Michael, Nielsen, Tina, Morschhauser, Franck, Rummel, Mathias, Hagenbeek, Anton, Vitolo, Umberto, Salles, Gilles A., Shi, Qian, Flowers, Christopher R.
• Format: Article
• Language: English
• Subjects: Aged; Humans; Life Sciences; Lymphoid Neoplasia; Lymphoma, Follicular - drug therapy; Medicin och hälsovetenskap; Progression-Free Survival; Proportional Hazards Models; Randomized Controlled Trials as Topic
• ISSN: 2473-9529; 2473-9537; 2473-9537
• DOI: 10.1182/bloodadvances.2020002724

Limited data exist to describe the clinical features and outcomes for elderly patients with follicular lymphoma (FL). The Follicular Lymphoma Analysis of Surrogacy Hypothesis (FLASH) group performed a prospectively planned pooled analysis of individual patient data from first-line randomized controlled trials (RCTs) and examined associations between age (≤70 vs >70 years), clinical characteristics, and FL outcomes. We identified 18 multicenter clinical RCTs in the FLASH database that enrolled elderly patients (>70 years). Primary end points were early disease outcomes, CR24 and CR30, and progression-free survival (PFS) at 24 months (PFS24). Secondary end points were PFS and overall survival (OS). We identified 5922 previously untreated FL patients from 18 RCTs. Patients age >70 years (vs ≤70 years) more commonly had elevated lactate dehydrogenase, hemoglobin 70 years did not differ from patients ≤70 years in rates of CR24, CR30, or PFS24. With a median OS of 14.6 years for all patients, median OS was 7.4 and 15.7 years for patients >70 and ≤70 years of age, respectively (hazard ratio = 2.35; 95% confidence interval = 2.03-2.73; P < .001). Age >70 years was a significant predictor of OS and PFS due to higher rates of death without progression, but not PFS24, CR24, or CR30. FL patients >70 years treated on trials have similar early disease outcomes to younger patients. There is no disease-specific outcome difference between age groups. Age alone should not disqualify patients from standard treatments or RCTs. •Older patients with FL have similar early disease outcomes to younger patients.•Age alone should not disqualify older FL patients from standard treatments or RCTs. [Display omitted]