The introduction of rituximab in 2003 has had a positive effect on outcomes for patients with follicular lymphoma (FL). Both relative and conditional survival increased, mainly due to the introduction of rituximab, and mortality decreased. This is evident from the thesis of Dr. Manette Dinnessen (IKNL/University of Amsterdam). Dinnessen used data from the Dutch Cancer Registry to investigate various epidemiological aspects of FL, specifically aimed at the effectiveness of rituximab-containing therapies.
Relative survival is increasing
The survival of patients with FL has increased substantially since 2003 compared to 1996-2002. This increase is related to the introduction of rituximab in the Netherlands in 2003. Survival increased particularly strongly in patients with stage III-IV FL, mainly due to the introduction of rituximab. Dinnessen attributes the increased relative survival in patients with early stage (I-II) FL, especially the elderly, to better supportive care and also the addition of rituximab to treatment. Finally, improvement in relative survival was greatest among older age groups. This is mainly due to advances in treatment and supportive care. Learn more about the relative survival study in FL.
Conditional survival is also increasing
Dinnessen also examined conditional relative survival. Dinnessen: ‘Relative survival estimated at diagnosis is informative when it comes to the prognosis at diagnosis, but becomes less meaningful the longer a patient survives. So we looked at the five-year relative survival at diagnosis and after each year since diagnosis through 10 years after diagnosis, conditionally on being alive at the beginning of that year.’ It appears that conditional relative survival also increases steadily with each year survived since diagnosis. Strikingly, the differences in survival between patients with different disease stages (stages I-II versus III-IV) disappear seven years after diagnosis, mainly due to the increasing survival with each surviving year of patients with stage III-IV follicular lymphoma. There are differences in age groups. For example, conditional survival appears to be lowest in the 70+ patients. Learn more about the conditional survival study in FL.
Mortality from follicular lymphoma is decreasing
The number of patients dying from FL has decreased across the population since the introduction of rituximab in 2003. This is shown by research into causes of death of patients with FL. Patients older than 60 years with stage III-IV disease at diagnosis still have a poor prognosis. Dinnessen thinks that mapping the causes of death of patients with follicular lymphoma can have consequences for treatment. “The proposed treatment plan is tailored to the individual, taking several factors into consideration. The disease stage, age and the presence of other diseases. In addition, we know that many of the available treatments increase the risk of heart damage or developing other forms of cancer.’ Read more about the research into causes of death among patients with FL.
More information
Dr. Manette Dinnessen received her PhD on 20 October for her thesis ‘Deciphering the epidemiology of follicular lymphoma: population-based studies in the Netherlands’. In this thesis, in addition to the topics described, Dinnessen also investigated the risk of second primary malignancies in FL patients and the effectiveness of different chemotherapies. The supervisor was Prof. Dr. MJ Kersten (Amsterdam UMC). Co-promoters were Dr AG Dinmohamed (IKNL) and Dr PJ Lugtenburg (Erasmus MC).