There are few studies that analyze follicular lymphoma (FL) mortality compared to the general population of the same -sex and age group. Given the recent clinical relevance of the predictive event-free survival (EFS) indexes EFS12 and EFS24, we obtained them in our study cohort in order to estimate their association with overall survival (OS).
Patients diagnosed with FL were prospectively enrolled from 1980 to 2013. Standardized mortality ratios (SMR) were obtained using yearly sex and age specific mortality rates in Spain, and OS was compared with age- and sex-matched general population data. EFS were defined as the time from diagnosis until relapse or progression, unplanned retreatment of lymphoma after initial management, or death due to any cause. EFS12 and 24 were defined as EFS status at 12 or 24 months from diagnosis, respectively. The crude probability of death was estimated by using the Kaplan–Meier method, and differences between patient groups were assessed by the log-rank test. In order to investigate the specific contribution of age, sex, period of diagnosis, treatment and FLIPI score, a multivariable Cox proportional hazards model was adjusted, all statistical tests were two-sided, and a p-value
A total of 1074 patients with newly diagnosed FL were enrolled. The median OS was 231 months (CI 95% 195-267). EFS at 12 and 24 months was associated with increased probability of early death, with an SMR of 10.27 (95% CI: 8.26-12.77). The prognostic value of traditional scales such as FLIPI is maintained in our study, with a hazard ratio of 2.7 (95% CI: 1.9- 4.0) for a score of 2-5. Of note, no significant difference in mortality was observed between FL patients at 10 years since diagnosis compared to the general population (SMR of 1.02; 95% CI 0.57, 1.85).
EFS12 and 24 predicted an early increase in mortality. The long-term SMR, over 10 years of follow-up, shows that patients with FL have a similar risk of dying than the general population of the same sex and age.
Clinical trial identification
Legal entity responsible for the study
GOTEL (Spanish Lymphoma Oncology Group)
All authors have declared no conflicts of interest.