Improved Lymphoma Survival Over 20 Years

Here's another article I'm kind of catching up on. It was published about 4 weeks ago in the journal Cancer Medicine, and it's called "Improving Survival of 3760 Patients with Lymphoma: Experience of an Academic Center Over Two Decades."


It's pretty interesting for what it doesn't say, as much as for what it does say.

The article looks at lymphoma survival rates over 20 years for patients in one hospital in China. That's a whole bunch of different types of lymphoma, including Follicular Lymphoma. And it looks at patients in a single hospital. So it's kind of really narrow and really broad at the same time. The kind of study that has so many limitations that it's hard to some up with any lessons from it.

But we'll try anyway.

The hospital is Beijing University Cancer Hospital and Institute. They looked back at the records of 3760 patients who were diagnosed with some type of lymphoma between 1996 and 2015. Then they divided the patients into four groups, depending on when they were diagnosed: 1996‐2000, 2001‐2005, 2006‐2010, and 2010‐2015. Then they looked at the 5 year and 10 year Overall Survival rates for each of those groups.

They found that the, for all 3760 patients, the 5 year survival rate was 62%, and the 10 year OS was 52%. Remember, that's for ALL lymphomas -- indolent ones like FL, but also aggressive ones, and for patients of ALL ages, from 20 year olds to 90 year olds.

When they looked at individual lymphomas, they found that the 5 year Overall Survival was highest for Follicular Lymphoma -- 77.8%. That's great news for us!

Just as important, they found that the 5 year OS went up over time. The 5 year OD for patients with B Cell Lymphomas (including FL) was 49% for the group diagnosed from 1996-2000, but went up to 65% for the group diagnosed from 2011-2015.

For FL specifically, the 5 year OS went up, from 42.9% for 1996-2000, to 77.6% for 2011-2015.  Once again, that's excellent news for us!

But, as I said, there are limitations to this study -- things that make it hard for us to learn any big lessons from it. It was, after all, a look at patients from just one hospital, and such a small, focused group can have all kinds of issues that influence the numbers that we see. It could be, for example, that a large number of the patients worked in a particular industry (like coal, or chemicals) that could have shortened their life spans in ways that had nothing to do with the lymphoma. In fact, the researchers here say that some of the factors they think helped cause the improvement were things like an increase in the number of doctors and hospital beds in China over 20 years, as well as changes that made it easier for people to afford treatment.

Still, some other things do fit a larger pattern. Rituxan was approved (in the United States, anyway) in 1997, and, as the article points out, in 2000 in China. Overall Survival rates for FL climbed steadily after that in both countries. Rituxan has a way of making some other treatments even better (which is why it is often included in combinations -- Bendamustine + Rituxan, R-Squared, etc.).

Overall Survival for Follicular is improving. When I was diagnosed 12 years ago, I remember reading that the OS fr FL was 8-10 years. These days it's probably closer to 20 years. And I say "probably" because there haven't been many recent studies to confirm that. There's a good reason: OS is a measure of the median, the middle point in a list. So the median survival rate says half of the people in a study have lived less than that number and half have lived more. It's been hard to measure a median OS because not enough people in those studies have died for them to calculate the number. So 18-20 years in their best guess.

(This is a good time to remind you that median Overall Survival says nothing about you as an individual. Read what I wrote here to remind you of what OS means.)

So what can this article tell us? In some ways, not much, other than what it can tell us about a bunch of patients over 20 years in one hospital in China.

But in other ways, it confirms a pattern -- people diagnosed with Follicular Lymphoma are living longer than they used to, for lots of reasons. And I think l there is good reason to think the pattern will continue -- more and better treatments in the future (especially if people are willing to be part of clinical trials), and more reasons for us to be hopeful.