title: Disease characteristics, treatment patterns, and outcomes of follicular lymphoma in patients 40 years of age and younger: an analysis from the National Lymphocare Study†.
abstract: BACKGROUND
  Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma, with median age at diagnosis in the seventh decade. FL in young adults (YAs), defined as diagnosis at ≤40 years, is uncommon. No standard approaches exist guiding the treatment of YA FL, and little is known about their disease characteristics and outcomes. To gain further insights into YA FL, we analyzed the National LymphoCare Study (NLCS) to describe characteristics, initial treatments, and outcomes in this population versus patients aged >40 years.
  
  
  METHODS
  Using the NLCS database, we stratified FL patients by age: 18-40 (YA), 41-60, 61-70, 71-80, and >80 years. Survival probability was estimated using Kaplan-Meier methodology. We examined associations between age and survival using hazard ratios and 95% confidence intervals (CIs) from multivariable Cox models.
  
  
  RESULTS
  Of 2652 eligible FL patients in the NLCS, 164 (6%) were YAs. Of YA patients, 69% had advanced disease, 80% had low-grade histology, and 50% had good-risk disease according to the Follicular Lymphoma International Prognostic Index (FLIPI). Nineteen percent underwent observation, 12% received rituximab monotherapy, and 46% received chemoimmunotherapy [in 59% of these: R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone)]. With a median follow-up of 8 years, overall survival (OS) at 2, 5, and 8 years was 98% (95% CI 93-99), 94% (95% CI 89-97), and 90% (95% CI 83-94), respectively. Median progression-free survival (PFS) was 7.3 years (95% CI 5.6-not reached).
  
  
  CONCLUSIONS
  In one of the largest cohorts of YA FL patients treated in the rituximab era, disease characteristics and outcomes were similar to patients aged 41-60 years, with favorable OS and PFS in YAs. Longer-term outcomes and YA-specific survivorship concerns should be considered when defining management. These data may not support the need for more aggressive therapies in YA FL.
  
  
  BACKGROUND
  Roche/Genentech ML01377 (U2963n).
authors.affiliation: James P. Wilmot Cancer Center, University of Rochester, Rochester.
authors.forename: C
authors.initials: C
authors.lastname: Casulo
authors.affiliation: Genentech, Inc., South San Francisco.
authors.forename: B
authors.initials: B
authors.lastname: Day
authors.affiliation: Genentech, Inc., South San Francisco.
authors.forename: K L
authors.initials: KL
authors.lastname: Dawson
authors.affiliation: RTI Health Solutions, Research Triangle Park, Durham.
authors.forename: X
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Medicine, Emory University, Atlanta.
authors.forename: C R
authors.initials: CR
authors.lastname: Flowers
authors.affiliation: Carol G. Simon Cancer Center, Morristown.
authors.forename: C M
authors.initials: CM
authors.lastname: Farber
authors.affiliation: Sarah Cannon Research Institute, Nashville.
authors.forename: J D
authors.initials: JD
authors.lastname: Hainsworth
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester.
authors.forename: J R
authors.initials: JR
authors.lastname: Cerhan
authors.affiliation: University of Iowa, Iowa City.
authors.forename: B K
authors.initials: BK
authors.lastname: Link
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Zelenetz
authors.affiliation: James P. Wilmot Cancer Center, University of Rochester, Rochester jonathan_friedberg@urmc.rochester.edu.
authors.forename: J W
authors.initials: JW
authors.lastname: Friedberg
mesh_terms: D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008224:Lymphoma, Follicular / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D012042:Registries; D000069283:Rituximab / Q000008:administration & dosage*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: follicular lymphoma; outcomes; survival; treatment; young adults