ASH: 35 Year Follow-Up of Follicular Lymphoma Patients

 I'm doing my best to look at presentation from the ASH conference, which will take place in a few weeks. As usual, I'm seeing lots of press releases from pharmaceutical companies that talk about how great their new treatments are, and how well they are doing in various stages of clinical trials.

So far, though, nothing that I am seeing that is going to really change the treatment landscape at all. As you may know, I follow a lot of lymphoma specialists on Twitter, and so far, I haven't seen a lot of talk about any great breakthroughs about Follicular Lymphoma being presented at ASH (or, really, about any lymphomas). That could be because research has been slowed by Covid, or because the oncologists I follow have just been so overwhelmed that they haven't had much chance to really dive into the abstracts.

Whatever the case, that doesn't mean I won't find things to be excited about! Even small steps are still forward progress. So I'll keep reading and trying to find things to share. There's always something.

This time, the abstract that really caught my eye was one called "Thirty-Five Year Follow-up Analysis of Follicular Lymphoma Patients Treated through the Nebraska Lymphoma Study Group: Prognostic Factor Analysis and Outcomes." 

The paper looks at 1037 FL patients who were diagnosed between 1983 and 2020. That's a very long time span to look at, and it includes about 14 years before Rituxan was approved and widely used as part of FL treatments. (If you don't know, Rituxan really changed things for FL patients. It works pretty well on its own -- I haven't needed treatment in 10+ years after receiving Rituxan on its own -- but what makes it really great is that it improves lots of other treatments, too, and makes them more effective.)

I'll get right to thing that I had hoped I would see in this presentation. There was a median follow-up of just over 9 years (which means half the patients were followed up for less than 9 years, and half for more than 9), with a maximum follow-up of 36 years. That means that at least one FL patient in this study has survived for 36 years.

I try to be good about reminding everyone not to read statistics as destiny -- the median survival doesn't have anything to do with your own situation. But I also know lots of patients, especially newly-diagnosed, wonder things like "Will I see my kids or grandkids grow up?" So if you're looking at possibilities, hold on to that hope. Yes, it is possible to survive for a very long time with FL. 

The study looked at things like Progression-Free Survival and Overall Survival, and broke down the patient groups by age, treatment, and FLIPI Score. 

(A quick note on FLIPI Scores. I don't want to spend a lot of time on it -- I think Lymphomation.org does a nice job of explaining it. But the important thing about FLIPI, like anything that involves numbers, is that they are not destiny. The research here presents trends, but lots of patients fall outside the trend. Remember that.)

I won't go through everything that the abstract says, but what I found interesting was how much this confirmed what we already know -- some treatments do better (and last longer) than others, some patients have better outcomes, and some patients can live with the disease for a very, very long time.

As far as treatments go, it is clear that Rituxan has been a very important addition to FL treatments. The median PFS was a little over 12 years for the entire group. That's a lot lower than recent estimates, that some experts say is as much as 18 to 20 years these days. But remember -- this includes people diagnosed as far back as 1983, before a lot of the treatments that we have available today. For patients who received Rituxan (alone or as part of a combo), the median PFS was 16 years, and for those who did not (which would include those patients diagnosed between 1983 and 1997), it was a little under 10 years. Patients who had both anthracycline and rituximab (that is, R-CHOP) had a PFS of over 10 years, compared to those who had only Rituxan (5 years) and only CHOP (3 years). 

PFS is significantly longer at 10.6 yrs in pts treated with both anthracycline and rituximab containing regimen as compared to 5.3 yrs in pts treated with rituximab alone and 3.05 yrs in pts that had only anthracycline based regimen (p=<0.001) (Fig 4). The median OS also was significantly higher in the combination regimen group at 18.8 yrs as compared to 11.3 yrs in rituximab only group and 9 yrs in anthracycline based regimen group (p=<0.001). 

Overall Survival seemed to correlate with FLIPI score. Low FLIPI patients had a median OS of 15 years; intermediate FLIPI patients had an OS of just under 12 years; and High FLIPI about 5 years. (Again, I'll remind you that FLIPI scores are not your destiny. They are scored by looking at several factors that indicate certain risks. A higher score means you have more of these risks, and often a more aggressive lymphoma. It makes sense that lower PFS and OS scores would result, especially when you lump people diagnosed in 1983 with those diagnosed in 2015.)

Focusing on patients who had relapsed or died after that 10 years (190 out of the 1037), the study found that 13% died from their lymphoa, 4% from a different cancer, 2% from something related to their treatment, 23% from something not related to their disease, and 56% unknown. Another 278 patients survived longer than 10years, and 119 of them had gone over 10 years without a relapse.

It's all very interesting, looking at a group over 35 years. 

Is it useful? Yes, in many ways. It would be a lot more useful to look at the group over time -- what the numbers are for patients before Rituxan was approved, versus those from the last 10 years or so. Then we'd really see how much better off we are today than we would have been 30 years ago. (And there are lots of studies that do that, including this one from a few months ago.)

Still, if nothing else, the study confirms what I said above -- some treatments do better (and last longer) than others, some patients have better outcomes, and some patients can live with the disease for a very, very long time.

There's lots to be hopeful about and thankful for. I'm not one to say we have a "good cancer" or that cancer is a good thing in general. But I think it's true that medicine progresses, and that whoever we are, wherever we are, we're probably better off in many ways than those who came before us. 

More ASH abstracts soon.