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We examined real\u2010life outcomes of older patients with follicular (FL), mantle cell (MCL), or marginal zone\/lymphoplasmacytic lymphoma (MZL\/LPL), treated with these first\u2010line regimens. We identified Medicare beneficiaries with FL, MCL, or MZL\/LPL, who received either first\u2010line BR or RCHOP\/RCVP in 2009\u20102016, and matched groups using a propensity score. Outcomes of claims\u2010based event\u2010free survival (EFS), overall survival (OS), toxicity, secondary cancers, and costs were compared in the aggregate cohort (N = 2736), and in separately matched histology\u2010specific subcohorts. In the aggregate cohort, EFS was better with BR than with RCHOP\/RCVP (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.70\u20100.87). Acute toxicity was lower with BR, including rates of hospitalizations (33% vs 45%), infections (21% vs 30%), cardiovascular events, and transfusions, yet OS did not differ (HR, 1.03; 95% CI, 0.91\u20101.17) and Medicare spending was higher. There was no difference in the cumulative incidence of secondary cancers (subhazard ratio, 1.11; 95% CI, 0.83\u20101.48). The EFS advantage of BR was pronounced in MCL (N = 690; HR, 0.64; 95% CI, 0.54\u20100.76), but less so in FL (N = 1330; HR, 0.83; 95% CI, 0.69\u20100.98) and absent in MZL\/LPL (N = 574; HR, 0.92; 95% CI, 0.73\u20101.17). Despite improved EFS and lower toxicity, the shift from RCHOP\/RCVP to BR in clinical practice did not improve OS for older patients with indolent B\u2010cell lymphomas. Frequent infections and hospitalizations underscore the need for safer treatment approaches in this population. Secondary cancers do not appear to be increased after BR compared with RCHOP\/RCVP.<\/jats:p>","DOI":"10.1002\/ajh.25707","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T06:15:31Z","timestamp":1576649731000},"page":"354-361","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Outcomes of bendamustine\u2010 or cyclophosphamide\u2010based first\u2010line chemotherapy in older patients with indolent B\u2010cell lymphoma"],"prefix":"10.1002","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6472-6658","authenticated-orcid":false,"given":"Adam J.","family":"Olszewski","sequence":"first","affiliation":[{"name":"Department of Medicine Alpert Medical School of Brown University  Providence Rhode Island"},{"name":"Division of Hematology\u2010Oncology Rhode Island Hospital  Providence Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James N.","family":"Butera","sequence":"additional","affiliation":[{"name":"Department of Medicine Alpert Medical School of Brown University  Providence Rhode Island"},{"name":"Division of Hematology\u2010Oncology Rhode Island Hospital  Providence Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4877-6863","authenticated-orcid":false,"given":"John L.","family":"Reagan","sequence":"additional","affiliation":[{"name":"Department of Medicine Alpert Medical School of Brown University  Providence Rhode Island"},{"name":"Division of Hematology\u2010Oncology Rhode Island Hospital  Providence Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9490-7532","authenticated-orcid":false,"given":"Jorge J.","family":"Castillo","sequence":"additional","affiliation":[{"name":"Division of Hematologic Oncology Dana Farber Cancer Institute  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,2]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"585","volume-title":"WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues","author":"Swerdlow SH","year":"2017"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.74.1652"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2014.936013"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62175-7"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-11-531327"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61763-2"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-017-2529-9"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2017.025288"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1614598"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.76.8960"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200208001-00002"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-04-348367"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2016.0121"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29290"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2016.1228924"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2014.930853"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.2403"},{"key":"e_1_2_8_19_1","unstructured":"ElixhauserA SteinerC PalmerL. 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