Survival by First-line Treatment Type and Timing of Progression Among Follicular Lymphoma Patients: A National Population-based Study in Sweden.

Autor: Weibull CE; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden., Wästerlid T; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden., Wahlin BE; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.; Unit of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden., Andersson PO; Section for Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden., Ekberg S; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden., Lockmer S; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.; Unit of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden., Enblad G; Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden., Crowther MJ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.; Red Door Analytics, Stockholm, Sweden., Kimby E; Unit of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden., Smedby KE; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: HemaSphere [Hemasphere] 2023 Feb 23; Vol. 7 (3), pp. e838. Date of Electronic Publication: 2023 Feb 23 (Print Publication: 2023).
DOI: 10.1097/HS9.0000000000000838
Abstrakt: In follicular lymphoma (FL), progression of disease ≤24 months (POD24) has emerged as an important prognostic marker for overall survival (OS). We aimed to investigate survival more broadly by timing of progression and treatment in a national population-based setting. We identified 948 stage II-IV indolent FL patients in the Swedish Lymphoma Register diagnosed 2007-2014 who received first-line systemic therapy, followed through 2020. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by first POD at any time during follow-up using Cox regression. OS was predicted by POD using an illness-death model. During a median follow-up of 6.1 years (IQR: 3.5-8.4), 414 patients experienced POD (44%), of which 270 (65%) occurred ≤24 months. POD was represented by a transformation in 15% of cases. Compared to progression-free patients, POD increased all-cause mortality across treatments, but less so among patients treated with rituximab(R)-single (HR = 4.54, 95% CI: 2.76-7.47) than R-chemotherapy (HR = 8.17, 95% CI: 6.09-10.94). The effect of POD was similar following R-CHOP (HR = 8.97, 95% CI: 6.14-13.10) and BR (HR = 10.29, 95% CI: 5.60-18.91). The negative impact of POD on survival remained for progressions up to 5 years after R-chemotherapy, but was restricted to 2 years after R-single. After R-chemotherapy, the 5-year OS conditional on POD occurring at 12, 24, and 60 months was 34%, 46%, and 57% respectively, versus 78%, 82%, and 83% if progression-free. To conclude, POD before but also beyond 24 months is associated with worse survival, illustrating the need for individualized management for optimal care of FL patients.
(Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Hematology Association.)
Databáze: MEDLINE
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