Follicular lymphoma in Sweden: nationwide improved survival in the rituximab era, particularly in elderly women: a Swedish Lymphoma Registry study

• Published in: Leukemia Vol. 29; no. 3; pp. 668 - 676
• Main Authors: Junlén, H R, Peterson, S, Kimby, E, Lockmer, S, Lindén, O, Nilsson-Ehle, H, Erlanson, M, Hagberg, H, Rådlund, A, Hagberg, O, Wahlin, B E
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.03.2015
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antineoplastic Agents - therapeutic use; Cancer and Oncology; Cancer och onkologi; Care and treatment; Clinical Medicine; Diagnosis; Drug Dosage Calculations; Female; Gender; Geriatrics; Health risk assessment; Humans; Immunotherapy; Klinisk medicin; Lymphoma; Lymphoma, Follicular - drug therapy; Lymphoma, Follicular - mortality; Lymphoma, Follicular - pathology; Lymphomas; Male; Medical and Health Sciences; Medical research; Medicin och hälsovetenskap; Medicine, Experimental; Men; Middle Aged; Monoclonal antibodies; Older people; Patients; Practice Guidelines as Topic; Registries; Risk analysis; Risk factors; Rituximab; Sex Factors; Survival; Survival Analysis; Sweden; Targeted cancer therapy; Therapy; Women; Sweden
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/leu.2014.251

Treatment for follicular lymphoma (FL) improved with rituximab. In Sweden, first-line rituximab was gradually introduced between 2003 and 2007, with regional differences. The first national guidelines for FL were published in November 2007, recommending rituximab in first-line therapy. Using the population-based Swedish Lymphoma Registry, 2641 patients diagnosed with FL from 2000 to 2010 were identified and characterized by year and region of diagnosis, age (median, 65 years), gender (50% men), first-line therapy and clinical risk factors. Overall and relative survivals were estimated by calendar periods (2000-2002, 2003-2007 and 2008-2010) and region of diagnosis. With each period, first-line rituximab use and survival increased. Survival was superior in regions where rituximab was quickly adopted and inferior where slowly adopted. These differences were independent in multivariable analyses. Ten-year relative survival for patients diagnosed 2003-2010 was 92%, 83%, 78% and 64% in the age groups 18-49, 50-59, 60-69 and ⩾70, respectively. With increasing rituximab use, male sex emerged as an adverse factor. Survival improved in all patient categories, particularly in elderly women. The introduction and the establishment of rituximab have led to a nationwide improvement in FL survival. However, rituximab might be inadequately dosed in younger women and men of all ages.