title: Improvements in observed and relative survival in follicular grade 1-2 lymphoma during 4 decades: the Stanford University experience.
abstract: Recent studies report an improvement in overall survival (OS) of patients with follicular lymphoma (FL). Previously untreated patients with grade 1 to 2 FL treated at Stanford University from 1960-2003 were identified. Four eras were considered: era 1, pre-anthracycline (1960-1975, n = 180); era 2, anthracycline (1976-1986, n = 426); era 3, aggressive chemotherapy/purine analogs (1987-1996, n = 471); and era 4, rituximab (1997-2003, n = 257). Clinical characteristics, patterns of care, and survival were assessed. Observed OS was compared with the expected OS calculated from Berkeley Mortality Database life tables derived from population matched by gender and age at the time of diagnosis. The median OS was 13.6 years. Age, gender, and stage did not differ across the eras. Although primary treatment varied, event-free survival after the first treatment did not differ between eras (P = .17). Median OS improved from 11 years in eras 1 and 2 to 18.4 years in era 3 and has not yet been reached for era 4 (P < .001), with no suggestion of a plateau in any era. These improvements in OS exceeded improvements in survival in the general population during the same period. Several factors, including better supportive care and effective therapies for relapsed disease, are likely responsible for this improvement.
authors.affiliation: Department of Medicine, Oncology Division, Stanford University, Stanford, CA 94305, USA.
authors.forename: Daryl
authors.initials: D
authors.lastname: Tan
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Horning
authors.forename: Richard T
authors.initials: RT
authors.lastname: Hoppe
authors.forename: Ronald
authors.initials: R
authors.lastname: Levy
authors.forename: Saul A
authors.initials: SA
authors.lastname: Rosenberg
authors.forename: Bronislava M
authors.initials: BM
authors.lastname: Sigal
authors.forename: Roger A
authors.initials: RA
authors.lastname: Warnke
authors.forename: Yasodha
authors.initials: Y
authors.lastname: Natkunam
authors.forename: Summer S
authors.initials: SS
authors.lastname: Han
authors.forename: Alan
authors.initials: A
authors.lastname: Yuen
authors.forename: Sylvia K
authors.initials: SK
authors.lastname: Plevritis
authors.forename: Ranjana H
authors.initials: RH
authors.lastname: Advani
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002140:California; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab