title: Follicular lymphoma in Sweden: nationwide improved survival in the rituximab era, particularly in elderly women: a Swedish Lymphoma Registry study.
abstract: Treatment for follicular lymphoma (FL) improved with rituximab. In Sweden, first-line rituximab was gradually introduced between 2003 and 2007, with regional differences. The first national guidelines for FL were published in November 2007, recommending rituximab in first-line therapy. Using the population-based Swedish Lymphoma Registry, 2641 patients diagnosed with FL from 2000 to 2010 were identified and characterized by year and region of diagnosis, age (median, 65 years), gender (50% men), first-line therapy and clinical risk factors. Overall and relative survivals were estimated by calendar periods (2000-2002, 2003-2007 and 2008-2010) and region of diagnosis. With each period, first-line rituximab use and survival increased. Survival was superior in regions where rituximab was quickly adopted and inferior where slowly adopted. These differences were independent in multivariable analyses. Ten-year relative survival for patients diagnosed 2003-2010 was 92%, 83%, 78% and 64% in the age groups 18-49, 50-59, 60-69 and ⩾70, respectively. With increasing rituximab use, male sex emerged as an adverse factor. Survival improved in all patient categories, particularly in elderly women. The introduction and the establishment of rituximab have led to a nationwide improvement in FL survival. However, rituximab might be inadequately dosed in younger women and men of all ages.
authors.affiliation: Division of Hematology, Department of Medicine at Huddinge, Karolinska Institutet, and Hematology Center, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: H R
authors.initials: HR
authors.lastname: Junlén
authors.affiliation: Department of Statistics, Regional Cancer Center in South Sweden, Lund, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Peterson
authors.affiliation: Division of Hematology, Department of Medicine at Huddinge, Karolinska Institutet, and Hematology Center, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Kimby
authors.affiliation: Division of Hematology, Department of Medicine at Huddinge, Karolinska Institutet, and Hematology Center, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Lockmer
authors.affiliation: Department of Oncology, Lund University Hospital, Lund, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Lindén
authors.affiliation: Section of Hematology and Coagulation, Department of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Nilsson-Ehle
authors.affiliation: Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Erlanson
authors.affiliation: Department of Oncology, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Hagberg
authors.affiliation: Department of Oncology, Ryhov County Hospital, Jönköping, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Rådlund
authors.affiliation: Department of Statistics, Regional Cancer Center in South Sweden, Lund, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Hagberg
authors.affiliation: Division of Hematology, Department of Medicine at Huddinge, Karolinska Institutet, and Hematology Center, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: B E
authors.initials: BE
authors.lastname: Wahlin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012042:Registries; D000069283:Rituximab; D012737:Sex Factors; D016019:Survival Analysis; D013548:Sweden
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab