title: Minimal Loss of Lifetime for Patients With Diffuse Large B-Cell Lymphoma in Remission and Event Free 24 Months After Treatment: A Danish Population-Based Study.
abstract: Purpose The general outlook for patients with diffuse large B-cell lymphoma (DLBCL) in first remission is important information for patients and for planning post-treatment follow-up. The purpose of this study was to evaluate the survival of patients with DLBCL in remission compared with a matched general population. Methods A total of 1,621 patients from the Danish Lymphoma Registry who were newly diagnosed with DLBCL between 2003 and 2011 were included in this study. All patients were ≥ 16 years of age at diagnosis and had achieved complete remission or complete remission unconfirmed after first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like therapy. Results The 5-year post-treatment DLBCL survival was inferior to survival in the matched general population (78%; 95% CI, 76 to 80; v 87%; standardized mortality ratio, 1.75; P < .001). Excess mortality was present but reduced for patients achieving post-treatment event-free survival for 24 months (pEFS24; standardized mortality ratio, 1.27; P < .001). In age-stratified analyses, the survival of patients < 50 years of age was normalized to the general population after achieving pEFS24 ( P = .99). During the first 8 years after pEFS24, the average loss of lifetime was 0.31 mo/y (95% CI, 0.11 to 0.50 mo/y). Excess mortality diminished when analyzing death from lymphoma as competing event to death from other causes, suggesting that early and late relapse is responsible for increased mortality in patients with DLBCL. Conclusion Although this population-based study does not support complete normalization of survival for patients with DLBCL achieving pEFS24, the estimated loss of residual lifetime was low for patients in continuous remission 2 years after ending treatment. Therefore, pEFS24 is an appealing and relevant milestone for patient counseling and could be a surrogate end point in clinical trials.
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Lasse Hjort
authors.initials: LH
authors.lastname: Jakobsen
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Bøgsted
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Peter de Nully
authors.initials: PN
authors.lastname: Brown
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Bente
authors.initials: B
authors.lastname: Arboe
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Judit
authors.initials: J
authors.lastname: Jørgensen
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Thomas Stauffer
authors.initials: TS
authors.lastname: Larsen
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Maja Bech
authors.initials: MB
authors.lastname: Juul
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Schurmann
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Linda
authors.initials: L
authors.lastname: Højberg
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Olav Jonas
authors.initials: OJ
authors.lastname: Bergmann
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Therese
authors.initials: T
authors.lastname: Lassen
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Pär Lars
authors.initials: PL
authors.lastname: Josefsson
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Paw
authors.initials: P
authors.lastname: Jensen
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Johnsen
authors.affiliation: Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark.
authors.forename: Tarec Christoffer
authors.initials: TC
authors.lastname: El-Galaly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003718:Denmark / Q000453:epidemiology; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008017:Life Expectancy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D000069283:Rituximab; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone