OBJECTIVES: Follicular Lymphoma (FL) is the most common indolent lymphoma (15,000 cases diagnosed in US, 2016). Limited evidence exists on racial differences in treatment and the comparative effectiveness of rituximab-based chemo/immunotherapy treatment regimens among elderly FL patients. Herein, we examined the differences in treatment utilization for elderly FL patients stratified by race and characterized the comparative effectiveness of treatments on cancer-specific and all-cause mortality. METHODS: We conducted a retrospective cohort study of patients (age≥66 years) diagnosed with first primary FL from 2001-2011, using the SEER-Medicare database. Differences in risk of all-cause and cancer-specific mortality by race were examined using Cox proportional hazards models. Adjusted hazard ratios and 95% CIs were also estimated to determine the comparative effectiveness of rituximab-based chemotherapy versus observation only. RESULTS: Among 4,849 elderly FL patients, treated patients tended to be younger than patients receiving observation only. African-American patients were less likely (44%) to receive treatment versus Caucasian patients (53%). Our findings suggested benefit of rituximab-based chemo/immunotherapy across all races, although only statistically significant for Caucasian patients, for cancer-specific mortality (Caucasian: HR=0.55, 95% CI:0.44-0.68; African-American: HR=0.62, 95% CI:0.30-1.41; Hispanic: HR=0.69, 95% CI:0.42-1.28; Asian/Pacific Islander : HR=0.65, 95% CI:0.27-1.40) and all-cause mortality (Caucasian: HR=0.53, 95% CI: 0.46-0.62; African-American: HR=0.61, 95% CI:0.28-1.93; Hispanic: HR=0.51, 95% CI:0.23-1.10; Asian/Pacific Islander : HR=0.54, 95% CI:0.20-0.94). Further subgroup analyses suggested similar benefits of rituximab plus chemotherapy and rituximab monotherapy when compared to observation (log-rank p<0.001). CONCLUSIONS: We found racial differences in the treatment utilization and comparative effectiveness of therapies in elderly FL patients. Some sociodemographic predictors may have an important role for treatment decisions. In this preliminary analysis it remains unclear if racial differences exist in the effectiveness of rituximab-based chemotherapy and monotherapy on cancer-specific and all-cause survival. Further analyses are planned to extend our analysis to all elderly indolent lymphoma patients.