Wednesday, June 26, 2013

Follicular Lymphoma Survival Statistics

The medical journal Blood, which focuses on, well, blood, has in its most recent issue an article called "Improvements in Observed and Relative Survival in Follicular Grade 1-2 Lymphoma over Four Decades: The Stanford University Experience." As the title implies, the study looks at survival statistics for Follicular Lymphoma patients at Stanford from 40 or so years, trying to determine what kind of progress we've made.

Apparently, we've made a bunch.

The study looked at four different time periods (or eras) of treatment of Follicular Lymphoma patients, tracking patients from each period, and comparing them.

Era 1 is the "Pre-anthracycline" Era, from 1960 to 1975. They looked at 180 patients from this period. Anthracycline is a powerful category of chemotherapy drugs that do a great job, but also cause some heart damage. For Follicular Lymphoma, CHOP is the most commonly used anthracycline-based treatment; specifically, it's the H in CHOP -- Hydroxydaunorubicin (Adriamycin). So Era 1 represents those years before we had CHOP, basically.

Era 2 is the "Anthracycline," Era, from 1976 to1986, when these treatments were most popular. They looked at 426 patients from this era.

Era 3, is the "Aggressive Chemotherapy/Purine Analogs" Era, from 1987 to 1996. They looked at 471 patients from these years. This era saw the popularity of Purine Analogues like Fludarabine. Really interesting concept: purine analogues mimic "purines," which is a substance that, among other things, makes up part of our DNA. So when a cancer cell divides, Fludarabine sneaks in and takes the place of a purine in the DNA, preventing the DNA from recombining and making a new cell. Unfortunately, Purine Analogues leave some nasty side effects: higher risk of infections, for example. And of developing leukemia.

Finally, there's Era 4, the "Rituximab" Era, from 1997 to 2003 (and, arguably, up to today, though that's changing pretty rapidly). They looked at 257 patients from this era.

In some ways, the different eras aren't all that significant, though I think that look at our treatment history is kind of fascinating.

Here's the important stuff:

Median Overall Survival (that is, death from any cause, not from FL specifically) was about 11 years in eras 1 and 2.  But it jumped to 18.4 years in era 3. As for era 4?  A median still hasn't been reached. Too many people still alive. That's a good thing. I think we can assume it will be higher than 18.4 years.

If you look at the Wikipedia page for Follicular Lymphoma, the prognosis section says that the median Overall Survival is about 10 years. I'm not going to link to it. It will only upset you. It certainly upset me when I was first diagnosed, and it upset a lot of my loved ones, to (because that's what we do when we don't understand something -- we Google it, and a Wikipedia entry is inevitably near the top of the results).

Ten years, especially to a 40 year old with 3 kids, is nothing. But 19 years (we're rounding up because we're optimistic)? That's a whole lot of time. Especially when you consider how rapidly we're progressing with treatments. Heck, we're probably on Era 6 by now.

I've said plenty of times that I avoid numbers, but I break that rule when the numbers are good.

And these are good.


Michael Buller said...

Hi Bob:
Been catching up on my blogger as I've been away from both writing and reading blogs for a while (not conscious decision, just busy). Really enjoying your June posts -- and particularly, this one. You should update the Wikipedia page yourself!
Thanks for the great updates.

Lymphomaniac said...

Thanks, Michael. Glad you're enjoying them, and glad your slow-down isn't health related. When I'm busy, I stop and remind myself that busy is good -- I'm healthy enough to have lots to do. Thanks for checking in.