Patterns of change in treatment, response, and outcome in patients with follicular lymphoma over the last four decades: a single-center experience

Pablo Mozas,Andrea Rivero,Neus Villamor,Alfredo Rivas-Delgado,Laura Magnano,Eva Giné,Tycho Baumann,Olga Balagué,Elías Campo,Marta Garrote,Armando López-Guillermo,Blanca González-Farré,Julio Delgado,Luis Veloza,Ferran Nadeu

doi:10.1038/s41408-020-0299-0

Abstract

Although the introduction of immunotherapy has improved outcomes for follicular lymphoma (FL) patients, histological transformation (HT) and early relapse still confer a poor prognosis. We sought to describe the patterns of change in treatment, response, and outcome of FL patients at our institution over the last four decades. Seven hundred and twenty-seven patients (389 F/338 M; median age, 57 years) consecutively diagnosed with grade 1-3a FL between 1980 and 2017, categorized into four decades according to the time of diagnosis, constituted the study population. Clinical characteristics, treatment, response, absolute and relative survival, HT, second malignancies (SM), and causes of death were assessed. Median OS for the entire cohort was 17.6 years. From decade 1 to 4, there was an increase in the complete response rate (48 to 70%), progression-free survival (40 to 56% at 5 years), OS (77 to 86% at 5 years), and relative survival ratio (0.83 to 0.94 at 5 years), with no significant differences in the risk of HT or SM. Lymphoma remained the most common cause of death in all four decades. These findings illustrate the overall improvement in outcome for FL patients, but support the need for further research into risk stratification and management.

Highlights

Follicular lymphoma (FL), the most common type of indolent B-cell lymphoma[1], is characterized by a long survival, despite a pattern of continuous relapses during follow-up[2], and shorter duration of responses in each relapse[3]
Data initially indicated that survival of FL patients had remained unchanged during the last three decades of the 20th century[4], more recent analyses have acknowledged that improvements in therapy, most likely related to the use of rituximab, as well as supportive measures, may have contributed to a better progression
Since the definition of disease-related or unrelated death might be a matter of discussion, we considered the following causes of death: progressive FL, treatmentrelated toxicities, neoplasms different from FL, and other/ unknown causes

Summary

Introduction

Follicular lymphoma (FL), the most common type of indolent B-cell lymphoma[1], is characterized by a long survival, despite a pattern of continuous relapses during follow-up[2], and shorter duration of responses in each relapse[3]. Data initially indicated that survival of FL patients had remained unchanged during the last three decades of the 20th century[4], more recent analyses have acknowledged that improvements in therapy, most likely related to the use of rituximab, as well as supportive measures, may have contributed to a better progression-. Some single-center and registry studies have described the changes in survival of FL patients over the last decades and trends in relative survival according to the general population[7,9]. To our knowledge, no single-center series has concurrently examined the trends in observed and relative survival, the risk of HT and second malignancies (SM), and the causes of death over a long period of time.

Methods

Results

Conclusion