title: Clinical characteristics and early treatment outcomes of follicular lymphoma in young adults.
abstract: Follicular lymphoma (FL) in young adults (YA, <40 years old) is uncommon, and the clinical characteristics and outcomes of this group are not well defined. We conducted a retrospective database review of 427 patients with newly diagnosed FL aged 65 years or less registered at Princess Margaret Cancer Centre between 1995 and 2010. YA (n = 61) and those 40-65 (n = 366) were compared with regards to clinical stage at diagnosis, FL International Prognostic Index (FLIPI) score, and the following clinical outcomes: time to second treatment, cause-specific survival (CSS) and overall survival (OS). At diagnosis, stage and FLIPI score were similar, as were the proportion of patients requiring therapy (YA 75% versus older adults 71%). Median follow-up was 8.1 years. Time to second therapy was similar in both age groups (5-year probability 23% YA versus 27% older adults; Gray's P-value = 0.76). Ten-year OS was significantly higher for YA (87% versus older adults 72%; P = 0.029). On multivariate analysis, age <40 years, low FLIPI score and observation as initial management were favourable prognostic factors for OS and CSS. We conclude that YA with FL have a favourable prognosis compared to older patients; whether this reflects competing mortality risks or age-related differences in lymphoma biology warrants further investigation.
authors.affiliation: Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Shane A
authors.identifier: http://orcid.org/0000-0003-1022-9899
authors.initials: SA
authors.lastname: Gangatharan
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Manjula
authors.initials: M
authors.lastname: Maganti
authors.affiliation: Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Kuruvilla
authors.affiliation: Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Vishal
authors.initials: V
authors.lastname: Kukreti
authors.affiliation: Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Rodger E
authors.initials: RE
authors.lastname: Tiedemann
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Gospodarowicz
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgson
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Sun
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Tsang
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Melania
authors.initials: M
authors.lastname: Pintilie
authors.affiliation: Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Crump
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008224:Lymphoma, Follicular / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: cancer; chemotherapy; lymphomas; non-Hodgkin lymphoma; prognostic factors