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. 2013 Aug 8;122(6):981-7.
doi: 10.1182/blood-2013-03-491514. Epub 2013 Jun 18.

Improvements in observed and relative survival in follicular grade 1-2 lymphoma during 4 decades: the Stanford University experience

Daryl Tan  1 , Sandra J Horning, Richard T Hoppe, Ronald Levy, Saul A Rosenberg, Bronislava M Sigal, Roger A Warnke, Yasodha Natkunam, Summer S Han, Alan Yuen, Sylvia K Plevritis, Ranjana H Advani
Affiliations

Improvements in observed and relative survival in follicular grade 1-2 lymphoma during 4 decades: the Stanford University experience

Daryl Tan et al. Blood. .

Abstract

Recent studies report an improvement in overall survival (OS) of patients with follicular lymphoma (FL). Previously untreated patients with grade 1 to 2 FL treated at Stanford University from 1960-2003 were identified. Four eras were considered: era 1, pre-anthracycline (1960-1975, n = 180); era 2, anthracycline (1976-1986, n = 426); era 3, aggressive chemotherapy/purine analogs (1987-1996, n = 471); and era 4, rituximab (1997-2003, n = 257). Clinical characteristics, patterns of care, and survival were assessed. Observed OS was compared with the expected OS calculated from Berkeley Mortality Database life tables derived from population matched by gender and age at the time of diagnosis. The median OS was 13.6 years. Age, gender, and stage did not differ across the eras. Although primary treatment varied, event-free survival after the first treatment did not differ between eras (P = .17). Median OS improved from 11 years in eras 1 and 2 to 18.4 years in era 3 and has not yet been reached for era 4 (P < .001), with no suggestion of a plateau in any era. These improvements in OS exceeded improvements in survival in the general population during the same period. Several factors, including better supportive care and effective therapies for relapsed disease, are likely responsible for this improvement.

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Figures

Figure 1
Figure 1
EFS after first treatment course by era of diagnosis. (A) All patients. (B) Patients with no initial therapy. (C) Patients receiving immediate treatment.
Figure 2
Figure 2
OS by era of diagnosis. (A) All patients. (B) Patients with no initial therapy. (C) Patients receiving immediate treatment.
Figure 3
Figure 3
OS by time to first treatment.
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