Friday, September 18, 2015

Follicular Lymphoma in Younger People

Hey all you youngsters -- diagnosed with Follicular Lymphoma before you were 40 years old -- the Annals of Oncology has some good news.

The median Overall Survival for younger patients is 24 years, and getting better.

Compare that to the median Overall Survival for FL patients, which, depending on the study, is anywhere from 8 to 15 years. That's a pretty good difference.

Of course, I was diagnosed about 6 months after I turned 40, so I'm not counted in this good news. (Which I am trying hard not be angry about.....)

 The study is part of a larger study of 1002 patients from four European Oncology Centers (Barcelona, Spain; Bellinzona, Switzerland; London, UK; and Novara, Italy) between 1985 to 2010. From there, they looked at 155 that were under 40.

They found that, after a median 10 year follow-up, they found the median OS to be 24 years. Keep in mind what "median" means -- half of the patients were below 24 years, and half were above it.

The study found some other things, too. Compared to older folks (over 40), the under 40's were less likely to have elevated LDH, high beta2-microglobulin, and high risk FLIPI scores (all signs of more aggressive disease). However, younger folks were more likely to have bone marrow involvement, bulky disease (larger nodes or infected organs), and disseminated lymphadenopathy (swollen nodes in several areas of the body) -- all of which are "bad," but not necessarily signs of aggressive disease.

Also compared to older folks, youngsters had a 10 year median OS of 81% (versus 51% for us older folks), and were more likely to have stable disease for longer.

Also, youngsters had longer Progression Free Survival and Cause Specific Survival if they were diagnosed within the last 20 years and have a low FLIPI score.

All of this is fantastic news.

With that in mind, here's some cold water: the conclusion to the study says " However, they still have a significantly shorter life expectancy than that of an age-matched general healthy population."

OK, that last part kind of stinks. But I'll take it. The overall message here is that Survival rates are getting better, not just for young people, but for all of us. And while, right now, we still have a shorter life expectancy than other folks, it's getting better. I have great hope that in 15 years (when I hit that 24 year OS), the landscape for treating Follicular Lymphoma is going to be so much different , so much better than we have now, that people will look back on my blog and giggle ("He thought about CVP? Ha! Was he a caveman?"). That's how much more advanced we will be.

Lots of good news here. As I've said before, I hate numbers and statistics -- except when they tell me something I want to hear.


Anonymous said...

Hi Bob,
I think this is the same data that was presented to the 2011 ASH convention in San Diego. Link as Follows:
Worth highlighting that this data is gathered over a period that started well before Rituximab and therefore like the 8-15 years quoted for older patients, the true median is likely to be considerably longer and probably nearer 20 years as suggested by Stanford.
Last but not least , like you I was diagnosed at Stage 1 so also worth mentioning that these statistics are based on the overwhelming majority of patients not being diagnosed until an advanced Stage 3 or 4 (85%), so hopefully earlier stage patients can add a good few years to the average!
Take care

Anonymous said...

Just to clarify my reference to 20 years is for older patients.


Rodrigo Carvalho said...

I was diagnosed with FL with 38 y.o, non bone marrow envolved, FLIPI I (Stage 1).
As you said BOb, I do think that in a new future the OS will improve a lot.
People will say "No big difference between healthy people and the ones who have FL in OS".
Just a question: Part of the study (24 y.o of OS) was made in pre-rituximab, isn´t it?
It makes sense because rituximab doesn´t achieve 24 years of using (1997-2015).
So it means that we don´t have a clear datas about OS AFTER rituximab. Am I right?
Thanks again.