Real-world treatment patterns and clinical outcomes in patients with follicular lymphoma: a SEER-Medicare analysis

Treatment sequencing and survival outcomes in follicular lymphoma (FL) are heterogeneous. This study describes real-world treatment patterns and outcomes among older patients with FL in the United States. Patients aged ≥65 years diagnosed with FL were identified from Surveillance, Epidemiology, and End Results-Medicare (2000-2017) and followed up through 2019. A total of 13 423 patients with FL (median age, 76 years at diagnosis) were included. With a median follow-up of 57.1 months, 38% of patients had no record of initiating any systemic treatment during the observation window; 62%, 23%, 9%, and 4% received ≥1, ≥2, ≥3, and ≥4 lines of therapy (LOTs), respectively. Survival rates increased significantly (P < .0001) over time, as evidenced by a 21% and 36% reduction in mortality risk among patients diagnosed in 2006-2011 and 2012-2017, respectively, compared with those diagnosed in 2000-2005. Chemoimmunotherapy was the most common treatment across LOTs. In ≥1, ≥2, ≥3, and ≥4 LOTs, median event-free survival was 33.1, 19.3, 15.5, and 13.0 months, respectively, and median overall survival (OS) was 79.6, 47.5, 32.8, and 26.1 months, respectively. Older age, advanced FL stage, and high comorbidity index at diagnosis were associated with shorter OS. Patients who progressed within 24 months following first-line therapy and those who received third-line therapy within 36 months also had shorter OS from diagnosis, as did patients with double-refractory disease. Despite recent improvement in treatment outcomes, there remains an unmet medical need for older, high-risk patients with FL.