Sarkozy C, et al. - Researchers investigated the causes of death (CODs) in patients with follicular lymphoma (FL) in the rituximab era. They found that, although the patients demonstrated improved overall survival, lymphoma was documented as the leading COD, especially after disease transformation. A need for less-toxic therapies was acknowledged on account of the observed treatment-related mortality.

Methods

• Two cohorts of newly diagnosed patients with FL grade 1-3A were pooled.
• Enrollment of patients was carried out between 2001 and 2013 in two French referral institutions (N = 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 = 920; median follow-up 84 months).
• The varoius categories of COD included as being a result of lymphoma, other malignancy, treatment related, or all other causes.

Results

• Findings revealed comparable 10-year overall survival in the French (80%) and US (77%) cohorts.
• In 248 (88%) of 283 decedents, the classification of COD was possible.
• The most commonly documented COD in the overall cohort was lymphoma, 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%).
• 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%), for patients who failed to achieve event-free survival within 24 months from diagnosis (36.1% v 7.0%), and for patients with a history of transformed FL (45.9% v 4.7%), a higher 10-year cumulative incidence of death as a result of lymphoma or treatment vs death as a result of all other causes was observed, this finding was not true for Follicular Lymphoma International Prognostic Index score 0 to 1 (4.0% v 3.7%), for patients who achieved event-free survival within 24 months of diagnosis (6.7% v 5.7%), and for patients without (8.1% v 6.2%).
• In patients whose FL transformed after diagnosis, 77 of 140 deaths as a result of lymphoma occurred.