1 Hospices Civils de Lyon, Centre Hospitalier Lyon Sud; Université de Lyon, Université Claude Bernard Lyon 1, Centre de Recherche en Cancérologie de Lyon INSERM 1052, Lyon, France.
2 Mayo Clinic, Rochester, MN.
J Clin Oncol. 2019 Jan 10;37(2):144-152. doi: 10.1200/JCO.18.00400. Epub 2018 Nov 27.
Although the life expectancy of patients with follicular lymphoma (FL) has increased, little is known of their causes of death (CODs) in the rituximab era.
We pooled two cohorts of newly diagnosed patients with FL grade 1-3A. Patients were enrolled between 2001 and 2013 in two French referral institutions (N = 734; median follow-up 89 months) and 2002 and 2012 in the University of Iowa and Mayo Clinic Specialized Program of Research Excellence (SPORE; N = 920; median follow-up 84 months). COD was classified as being a result of lymphoma, other malignancy, treatment related, or all other causes.
Ten-year overall survival was comparable in the French (80%) and US (77%) cohorts. We were able to classify COD in 248 (88%) of 283 decedents. In the overall cohort, lymphoma was the most common COD, with a cumulative incidence of 10.3% at 10 years, followed by treatment-related mortality (3.0%), other malignancy (2.9%), other causes (2.2%), and unknown (3.0%). The 10-year cumulative incidence of death as a result of lymphoma or treatment was higher than death as a result of all other causes for each age group (including patients ≥ 70 years of age at diagnosis [25.4% v 16.6%]) Follicular Lymphoma International Prognostic Index score 3 to 5 (27.4% v 5.2%), but not Follicular Lymphoma International Prognostic Index score 0 to 1 (4.0% v 3.7%); for patients who failed to achieve event-free survival within 24 months from diagnosis (36.1% v 7.0%), but not for patients who achieved event-free survival within 24 months of diagnosis (6.7% v 5.7%); and for patients with a history of transformed FL (45.9% v 4.7%), but not among patients without (8.1% v 6.2%). Overall, 77 of 140 deaths as a result of lymphoma occurred in patients whose FL transformed after diagnosis.
Despite the improvement in overall survival in patients with FL in the rituximab era, their leading COD remains lymphoma, especially after disease transformation. Treatment-related mortality also represents a concern, which supports the need for less-toxic therapies.
尽管滤泡性淋巴瘤（FL）患者的预期寿命有所延长，但在利妥昔单抗时代，他们的死亡原因（COD）知之甚少。
我们汇总了两个新诊断为 FL 1-3A 级的患者队列。患者于 2001 年至 2013 年在法国两个转诊机构（N=734；中位随访 89 个月）和 2002 年至 2012 年在爱荷华大学和 Mayo 诊所专门研究卓越计划（SPORE；N=920；中位随访 84 个月）中入组。COD 被分类为淋巴瘤、其他恶性肿瘤、治疗相关或所有其他原因。
法国（80%）和美国（77%）队列的 10 年总生存率相当。我们能够对 283 名死亡患者中的 248 名（88%）进行 COD 分类。在整个队列中，淋巴瘤是最常见的 COD，10 年累积发生率为 10.3%，其次是治疗相关死亡率（3.0%）、其他恶性肿瘤（2.9%）、其他原因（2.2%）和未知原因（3.0%）。对于每个年龄组（包括诊断时≥70 岁的患者），诊断后 10 年因淋巴瘤或治疗导致的死亡累积发生率高于因所有其他原因导致的死亡累积发生率[滤泡性淋巴瘤国际预后指数（FLIPI）评分 3-5 组：25.4%比 16.6%；FLIPI 评分 0-1 组：4.0%比 3.7%]，但对于诊断后 24 个月内未达到无事件生存的患者[27.4%比 5.2%]，而非达到无事件生存的患者[6.7%比 5.7%]；对于有转化性 FL 病史的患者[45.9%比 4.7%]，而非无转化性 FL 病史的患者[8.1%比 6.2%]。总体而言，140 例因淋巴瘤导致的死亡中，有 77 例发生在诊断后 FL 转化的患者中。
尽管利妥昔单抗时代 FL 患者的总体生存率有所提高，但他们的主要 COD 仍然是淋巴瘤，尤其是在疾病转化后。治疗相关死亡率也是一个令人关注的问题，这支持了使用毒性较小的治疗方法的必要性。
