Sarkozy C, et al. - Given an increase in the life expectancy of patients with follicular lymphoma (FL), researchers sought their causes of death (CODs) in the rituximab era. Findings revealed lymphoma as the leading COD, particularly following disease transformation. Concerns regarding treatment-related mortality support the necessity for less-toxic therapies.

Methods

• Two cohorts of newly diagnosed patients with FL grade 1-3A were pooled.
• Patients were enrolled 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).
• Classification of COD was done as being a result of lymphoma, other malignancy, treatment related, or all other causes.

Results

• The French (80%) and US (77%) cohorts were comparable in terms of 10-year overall survival.
• COD classification was done in 248 (88%) of 283 decedents.
• Lymphoma was noted to be the most common COD in the overall cohort, 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%).
• Researchers observed higher 10-year cumulative incidence of death as a result of lymphoma or treatment vs 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% v3.7%); 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%).
• FL transformation after diagnosis accounted for 77 of 140 deaths attributed to lymphoma occurrence.