Originally published as JCO Early Release 10.1200/JCO.2005.04.503 on June 27 2005

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Improved Survival of Follicular Lymphoma Patients in the United States

From the Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, College of Medicine, and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA

Address reprint requests to Brian K. Link, MD, C32 General Hospital, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242; e-mail: brian-link{at}uiowa.edu

PURPOSE: Despite several new treatment options, single- and multi-institution analyses have not clarified whether survival patterns in follicular lymphoma (FL) patients have changed in recent decades. We undertook a study using a large population-based registry to analyze survival patterns among patients with FL.

PATIENTS AND METHODS: Surveillance, Epidemiology, and End Results morphology codes were used to identify 14,564 patients diagnosed with FL between 1978 and 1999. Observed median survival times, Kaplan-Meier survival curves, proportional death hazard ratios, and relative survival rates were calculated. Joinpoint regression analysis was used to identify trends in annual adjusted death hazard ratios.

RESULTS: An improvement in survival of all patients with FL was observed between each of three diagnosis eras (1978 to 1985, 1986 to 1992, and 1993 to 1999) by log-rank tests. Among patients with stage-specific data, the median survival time improved from 84 months (95% CI, 81 to 88 months) in the 1983 to 1989 era to 93 months (95% CI, 89 to 97 months) in the 1993 to 1999 era. Similar findings were identified across sex and age groups and for subsets including advanced-stage, large-cell FL and the combined subset of small cleaved- and mixed-cell FL. The inter-era survival advantage observed in white patients was not observed for black patients. The relative risk of death decreased by 1.8% per year over the 1983 to 1999 observation period.

CONCLUSION: The survival of patients with FL in the United States has improved over the last 25 years. The survival improvement may be a result of the sequential application of effective therapies and improved supportive care.

Supported in part by National Cancer Institute grant Nos. T32 CA79445, HL 04117, and P50 CA097274.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004 (abstract ID: 1090).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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