OS of patients with FL at Stanford University significantly improved

[Guest guest]

Survival in Follicular Lymphoma: The Stanford Experience, 1960-2003. Session

Type: Poster Session, Board #647-III

Background: Recent data from retrospective and prospective studies indicate

an improvement in the overall survival (OS) of follicular lymphoma (FL)

patients (pt). We sought to evaluate survival data in FL pt managed at our

institution and to analyze their presenting features, management and disease

course.

Methods: Previously untreated FL (grades 1 and 2) pt referred from 1960-2003

and followed at Stanford were identified from the Lymphoma Database for this

retrospective study. Data were reviewed for quality and consistency of

coding for histology (pathology reviewed at Stanford) and treatment courses.

Four eras were defined by date of diagnosis

1 (1960-75, n=180);

2 (1976-86, n=426);

3 (1987-96, n=471); and

4 (1997-2003, n=257).

Patient (age, gender) and disease (stage, histology) characteristics,

management (time from diagnosis to referral, time to first treatment,

courses/types of treatment), and outcomes (progression-free survival [PFS],

OS, transformation) were evaluated, overall and with respect to era.

Results:

The OS for the 1334 FL pt in the dataset was 12.6 years (yr).

Age (median = 49 yr), gender (54% male) and stage (83% III-IV) did not

differ across the eras.

Median OS improved from 11.2 yr [95% CI 10.2,12.1] in eras 1 and 2 (1960-86)

to 18.4 yr [95% CI 14.5,22.4] in eras 3 and 4 (1986-2003), p<0.001.

Greatest gains were observed in pt less than 60 yr old and in advanced stage

disease.

OS was not different in eras 3 and 4 (p=0.56) but median follow-up is just 5

yr in era 4. Although treatment varied over the eras,

PFS was no longer for the later eras (3 and 4) compared to early eras (1 and

2), p=0.73.

Initial therapy was more likely to be deferred in the later eras: 16%, 44%,

59%, 60% for eras 1, 2, 3 and 4, respectively.

Rituximab use, as expected, varied over the eras:

1 (1% pt),

2 (8% pt),

3 (23% pt),

4 (42% pt).

The incidence of transformation was similar over the eras and OS after

transformation was significantly longer if patients were chemotherapy-naive

at transformation (p<0.001).

Conclusions: OS of patients with FL managed at Stanford University

significantly improved in the 1986-2003 eras, particularly among younger and

advanced stage patients. This improvement was not associated with longer PFS

after the first course of treatment or differences in the incidence of

histologic transformation.

Application of a time-variant regression model is in progress to better

understand the contributions of treatment, particularly rituximab, as well

as other factors in these patients.

Abstract #3428 appears in Blood, Volume 110, issue 11, November 16, 2007

Keywords: Indolent non-Hodgkin's Lymphoma|Transformation|Rituximab

Disclosure: No relevant conflicts of interest to declare.

Monday, December 10, 2007 5:00 PM

Session Info: Poster Session: Immunotherapy for Lymphoma, including

Radio-Immunotherapy (5:00 p.m.-7:00 p.m.)

Daryl Tan, Saul A. Rosenberg, Levy, Philip Lavori, Tibshirani,

T. Hoppe, Warnke, Ranjana Advani, Yasodha Natkunam, Alan Yuen,

J. Horning Oncology, Stanford University School of Medicine,

Stanford, CA, USA; Health Research and Policy, and Statistics, Stanford

University, Stanford, CA, USA; Radiation Oncology, Stanford University

School of Medicine, Stanford, CA, USA; Pathology, Stanford University School

of Medicine, Stanford, CA, USA