OBJECTIVES : Despite considerable improvements in available therapies for follicular lymphoma (FL), the most common indolent lymphoma, a consensus is lacking on optimal treatment sequencing. This study evaluated real-world treatment patterns among commercially insured FL patients in the United States.

METHODS : A retrospective cohort of newly diagnosed FL patients were identified from June-2008 to Sept-2016 using the IBM MarketScan® database. Patients were followed from FL diagnosis (defined by ICD-10 [c82.xx] and looking back for ICD-9 codes for FL or indolent Non-Hodgkin's Lymphoma) until loss of follow-up or end of the study. Outcome variables were the distribution of treatment regimens, line of therapy (LOT), and time to treatment.

RESULTS : Of 4,232 eligible FL patients with a median follow-up of 3.6 years, 2712 (64%) had at least one treatment for FL. Treated patients had a median age of 61 years, and 53% were male. 2,111 patients had only one LOT, 476 patients had two LOTs, and 175 patients had three or more LOTs. The most common first-line treatment included Bendamustine + Rituximab (B-R, 39%), Rituximab + Cyclophosphamide + Doxorubicin + Vincristine (RCHOP, 20%), and Rituximab monotherapy (R-mono, 19%). The most common second LOT were R-mono (34%), B-R (27%), and Rituximab + Cyclophosphamide + Vincristine (RCVP, 9%). Lastly, R-mono was most common (57%) for third or greater LOTs. Median time from FL diagnosis to initiation of first, second, and third LOT were 50, 577, and 776 days, respectively.

CONCLUSIONS : In a contemporary cohort of patients diagnosed with FL in the US, most patients had one or fewer lines of therapy during a median follow up of 3.6 years. Rituximab therapy predominated both in monotherapy and in combination. Consensus on optimal treatment sequencing is currently lacking, and patients receive a variety of active regimens during routine practice.