Addition of rituximab to chemotherapy alone as first-line therapy improves over-all survival in elderly patients with mantle cell lymphoma
A partir de données des registres américains du cancer et du système d'assurance-maladie Medicare entre1999 et 2007, cette étude évalue la survie associée à l'ajout du rituximab à une chimiothérapie de première ligne chez des patients âgés atteints d'un lymphome à cellules du manteau (âge moyen: 75 ans)
Clinical trials have demonstrated that rituximab improves overall survival in non-Hodgkin's lymphoma, except in mantle cell lymphoma (MCL). We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data to compare survival in older MCL patients who began chemotherapy +/- rituximab within 180 days of diagnosis. Patients were followed from diagnosis (1/1999-12/2005) until death or end of observation (12/2007). Medicare administrative and claims data were used to identify the date and cause of death, and the immunochemotherapy regimen. Among 638 patients, mean age at diagnosis was 75 years, 75% had Stage III/IV disease, 67% had extranodal involvement, and 64% received rituximab. The average length of first-line treatment was 21 weeks, with no difference between the two groups (P=0.76). Median survival was 27 months for chemotherapy alone compared to 37 months for chemotherapy plus rituximab (P<0.001). In multivariate analysis of two-year survival, rituximab plus chemotherapy was associated with lower all-cause (Hazard Ratio [HR] 0.58; 95% Confidence Interval [CI] 0.41-0.82; P<0.01), and cancer-specific (HR 0.56; 95% CI 0.37-0.84; P<0.01) mortality. Results were similar when using the entire observation period, using propensity score analysis, and limiting chemotherapy to CHOP/CHOP-like. First-line chemotherapy including rituximab is associated with significantly improved survival in older patients diagnosed with MCL.