Cause of death in follicular lymphoma in the first decade of the rituximab era

A pooled analysis of French and US cohorts

Clémentine Sarkozy, Matthew J. Maurer, Brian K. Link, Hervé Ghesquieres, Emmanuelle Nicolas, Carrie A Thompson, Alexandra Traverse-Glehen, Andrew L Feldman, Cristine Allmer, Susan L Slager, Stephen Maxted Ansell, Thomas Matthew Habermann, Emmanuel Bachy, James R Cerhan, Gilles Salles

Research output: Contribution to journalArticle

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Abstract

PURPOSE: Although the life expectancy of patients with follicular lymphoma (FL) has increased, little is known of their causes of death (CODs) in the rituximab era. PATIENTS AND METHODS: We pooled two cohorts of newly diagnosed patients with FL grade 1-3A. Patients were enrolled between 2001 and 2013 in two French referral institutions (N 5 734; median follow-up 89 months) and 2002 and 2012 in the University of Iowa and Mayo Clinic Specialized Program of Research Excellence (SPORE; N 5 920; median follow-up 84 months). COD was classified as being a result of lymphoma, other malignancy, treatment related, or all other causes. RESULTS: Ten-year overall survival was comparable in the French (80%) and US (77%) cohorts. We were able to classify COD in 248 (88%) of 283 decedents. In the overall cohort, lymphoma was the most common COD, with a cumulative incidence of 10.3% at 10 years, followed by treatment-related mortality (3.0%), other malignancy (2.9%), other causes (2.2%), and unknown (3.0%). The 10-year cumulative incidence of death as a result of lymphoma or treatment was higher than death as a result of all other causes for each age group (including patients $ 70 years of age at diagnosis [25.4% v 16.6%]) Follicular Lymphoma International Prognostic Index score 3 to 5 (27.4% v 5.2%), but not Follicular Lymphoma International Prognostic Index score 0 to 1 (4.0% v 3.7%); for patients who failed to achieve event-free survival within 24 months from diagnosis (36.1% v 7.0%), but not for patients who achieved event-free survival within 24 months of diagnosis (6.7% v 5.7%); and for patients with a history of transformed FL (45.9% v 4.7%), but not among patients without (8.1% v 6.2%). Overall, 77 of 140 deaths as a result of lymphoma occurred in patients whose FL transformed after diagnosis. CONCLUSION: Despite the improvement in overall survival in patients with FL in the rituximab era, their leading COD remains lymphoma, especially after disease transformation. Treatment-related mortality also represents a concern, which supports the need for less-toxic therapies.

Original languageEnglish (US)
Pages (from-to)144-152
Number of pages9
JournalJournal of Clinical Oncology
Volume37
Issue number2
DOIs
StatePublished - Jan 10 2019

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Follicular Lymphoma
Cause of Death
Lymphoma
Disease-Free Survival
Rituximab
Therapeutics
Survival
Mortality
Poisons
Incidence
Life Expectancy
Neoplasms
Referral and Consultation
Age Groups

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Cause of death in follicular lymphoma in the first decade of the rituximab era : A pooled analysis of French and US cohorts. / Sarkozy, Clémentine; Maurer, Matthew J.; Link, Brian K.; Ghesquieres, Hervé; Nicolas, Emmanuelle; Thompson, Carrie A; Traverse-Glehen, Alexandra; Feldman, Andrew L; Allmer, Cristine; Slager, Susan L; Ansell, Stephen Maxted; Habermann, Thomas Matthew; Bachy, Emmanuel; Cerhan, James R; Salles, Gilles.

In: Journal of Clinical Oncology, Vol. 37, No. 2, 10.01.2019, p. 144-152.

Research output: Contribution to journalArticle

Sarkozy, Clémentine ; Maurer, Matthew J. ; Link, Brian K. ; Ghesquieres, Hervé ; Nicolas, Emmanuelle ; Thompson, Carrie A ; Traverse-Glehen, Alexandra ; Feldman, Andrew L ; Allmer, Cristine ; Slager, Susan L ; Ansell, Stephen Maxted ; Habermann, Thomas Matthew ; Bachy, Emmanuel ; Cerhan, James R ; Salles, Gilles. / Cause of death in follicular lymphoma in the first decade of the rituximab era : A pooled analysis of French and US cohorts. In: Journal of Clinical Oncology. 2019 ; Vol. 37, No. 2. pp. 144-152.
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title = "Cause of death in follicular lymphoma in the first decade of the rituximab era: A pooled analysis of French and US cohorts",
abstract = "PURPOSE: Although the life expectancy of patients with follicular lymphoma (FL) has increased, little is known of their causes of death (CODs) in the rituximab era. PATIENTS AND METHODS: We pooled two cohorts of newly diagnosed patients with FL grade 1-3A. Patients were enrolled between 2001 and 2013 in two French referral institutions (N 5 734; median follow-up 89 months) and 2002 and 2012 in the University of Iowa and Mayo Clinic Specialized Program of Research Excellence (SPORE; N 5 920; median follow-up 84 months). COD was classified as being a result of lymphoma, other malignancy, treatment related, or all other causes. RESULTS: Ten-year overall survival was comparable in the French (80{\%}) and US (77{\%}) cohorts. We were able to classify COD in 248 (88{\%}) of 283 decedents. In the overall cohort, lymphoma was the most common COD, with a cumulative incidence of 10.3{\%} at 10 years, followed by treatment-related mortality (3.0{\%}), other malignancy (2.9{\%}), other causes (2.2{\%}), and unknown (3.0{\%}). The 10-year cumulative incidence of death as a result of lymphoma or treatment was higher than death as a result of all other causes for each age group (including patients $ 70 years of age at diagnosis [25.4{\%} v 16.6{\%}]) Follicular Lymphoma International Prognostic Index score 3 to 5 (27.4{\%} v 5.2{\%}), but not Follicular Lymphoma International Prognostic Index score 0 to 1 (4.0{\%} v 3.7{\%}); for patients who failed to achieve event-free survival within 24 months from diagnosis (36.1{\%} v 7.0{\%}), but not for patients who achieved event-free survival within 24 months of diagnosis (6.7{\%} v 5.7{\%}); and for patients with a history of transformed FL (45.9{\%} v 4.7{\%}), but not among patients without (8.1{\%} v 6.2{\%}). Overall, 77 of 140 deaths as a result of lymphoma occurred in patients whose FL transformed after diagnosis. CONCLUSION: Despite the improvement in overall survival in patients with FL in the rituximab era, their leading COD remains lymphoma, especially after disease transformation. Treatment-related mortality also represents a concern, which supports the need for less-toxic therapies.",
author = "Cl{\'e}mentine Sarkozy and Maurer, {Matthew J.} and Link, {Brian K.} and Herv{\'e} Ghesquieres and Emmanuelle Nicolas and Thompson, {Carrie A} and Alexandra Traverse-Glehen and Feldman, {Andrew L} and Cristine Allmer and Slager, {Susan L} and Ansell, {Stephen Maxted} and Habermann, {Thomas Matthew} and Emmanuel Bachy and Cerhan, {James R} and Gilles Salles",
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T1 - Cause of death in follicular lymphoma in the first decade of the rituximab era

T2 - A pooled analysis of French and US cohorts

AU - Sarkozy, Clémentine

AU - Maurer, Matthew J.

AU - Link, Brian K.

AU - Ghesquieres, Hervé

AU - Nicolas, Emmanuelle

AU - Thompson, Carrie A

AU - Traverse-Glehen, Alexandra

AU - Feldman, Andrew L

AU - Allmer, Cristine

AU - Slager, Susan L

AU - Ansell, Stephen Maxted

AU - Habermann, Thomas Matthew

AU - Bachy, Emmanuel

AU - Cerhan, James R

AU - Salles, Gilles

PY - 2019/1/10

Y1 - 2019/1/10

N2 - PURPOSE: Although the life expectancy of patients with follicular lymphoma (FL) has increased, little is known of their causes of death (CODs) in the rituximab era. PATIENTS AND METHODS: We pooled two cohorts of newly diagnosed patients with FL grade 1-3A. Patients were enrolled between 2001 and 2013 in two French referral institutions (N 5 734; median follow-up 89 months) and 2002 and 2012 in the University of Iowa and Mayo Clinic Specialized Program of Research Excellence (SPORE; N 5 920; median follow-up 84 months). COD was classified as being a result of lymphoma, other malignancy, treatment related, or all other causes. RESULTS: Ten-year overall survival was comparable in the French (80%) and US (77%) cohorts. We were able to classify COD in 248 (88%) of 283 decedents. In the overall cohort, lymphoma was the most common COD, with a cumulative incidence of 10.3% at 10 years, followed by treatment-related mortality (3.0%), other malignancy (2.9%), other causes (2.2%), and unknown (3.0%). The 10-year cumulative incidence of death as a result of lymphoma or treatment was higher than death as a result of all other causes for each age group (including patients $ 70 years of age at diagnosis [25.4% v 16.6%]) Follicular Lymphoma International Prognostic Index score 3 to 5 (27.4% v 5.2%), but not Follicular Lymphoma International Prognostic Index score 0 to 1 (4.0% v 3.7%); for patients who failed to achieve event-free survival within 24 months from diagnosis (36.1% v 7.0%), but not for patients who achieved event-free survival within 24 months of diagnosis (6.7% v 5.7%); and for patients with a history of transformed FL (45.9% v 4.7%), but not among patients without (8.1% v 6.2%). Overall, 77 of 140 deaths as a result of lymphoma occurred in patients whose FL transformed after diagnosis. CONCLUSION: Despite the improvement in overall survival in patients with FL in the rituximab era, their leading COD remains lymphoma, especially after disease transformation. Treatment-related mortality also represents a concern, which supports the need for less-toxic therapies.

AB - PURPOSE: Although the life expectancy of patients with follicular lymphoma (FL) has increased, little is known of their causes of death (CODs) in the rituximab era. PATIENTS AND METHODS: We pooled two cohorts of newly diagnosed patients with FL grade 1-3A. Patients were enrolled between 2001 and 2013 in two French referral institutions (N 5 734; median follow-up 89 months) and 2002 and 2012 in the University of Iowa and Mayo Clinic Specialized Program of Research Excellence (SPORE; N 5 920; median follow-up 84 months). COD was classified as being a result of lymphoma, other malignancy, treatment related, or all other causes. RESULTS: Ten-year overall survival was comparable in the French (80%) and US (77%) cohorts. We were able to classify COD in 248 (88%) of 283 decedents. In the overall cohort, lymphoma was the most common COD, with a cumulative incidence of 10.3% at 10 years, followed by treatment-related mortality (3.0%), other malignancy (2.9%), other causes (2.2%), and unknown (3.0%). The 10-year cumulative incidence of death as a result of lymphoma or treatment was higher than death as a result of all other causes for each age group (including patients $ 70 years of age at diagnosis [25.4% v 16.6%]) Follicular Lymphoma International Prognostic Index score 3 to 5 (27.4% v 5.2%), but not Follicular Lymphoma International Prognostic Index score 0 to 1 (4.0% v 3.7%); for patients who failed to achieve event-free survival within 24 months from diagnosis (36.1% v 7.0%), but not for patients who achieved event-free survival within 24 months of diagnosis (6.7% v 5.7%); and for patients with a history of transformed FL (45.9% v 4.7%), but not among patients without (8.1% v 6.2%). Overall, 77 of 140 deaths as a result of lymphoma occurred in patients whose FL transformed after diagnosis. CONCLUSION: Despite the improvement in overall survival in patients with FL in the rituximab era, their leading COD remains lymphoma, especially after disease transformation. Treatment-related mortality also represents a concern, which supports the need for less-toxic therapies.

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