PATTERNS OF SURVIVAL IN PATIENTS WITH RECURRENT FOLLICULAR LYMPHOMA -A 20-YEAR STUDY FROM A SINGLE-CENTER

Purpose: To examine outcome of treatment for patients with recurrent f ollicular lymphoma. Patients and Methods: Two hundred twelve newly dia gnosed follicular lymphoma patients were studied. One hundred seventy- nine were initially treated successfully. Recurrent or progressive lym phoma developed in 116. Treatment was given according to disease stage and current protocols, mostly with single alkylating agents. A policy of repeated lymph node and bone marrow biopsy was pursued. Results: T he overall median survival duration was 9 years, with a median follow- up duration of 12 years. Following recurrence, the median survival dur ation was 4 1/2 years. Only eight of 116 patients with recurrent disea se died of causes unrelated to lymphoma. The overall response rate to first re-treatment was 78% and showed slight decline with successive r ecurrences, reaching 48% after the fourth treatment. The median durati on of second remission was 13 months, (v 31 months for first remission ), with the only significant predictive factor being quality of remiss ion. Multivariate analysis showed only age at recurrence and number of prior treatments to correlate with survival after first recurrence. S urvival after second remission was only correlated with age and qualit y of response: Kaplan-Meier estimates gave 53% of patients reaching se cond complete remission alive 10 years later, compared with 28% in par tial remission. Conclusion: Age and previous and continuing responsive ness of follicular lymphoma to therapy are the principal determinants of survival following recurrence. Improvement in survival with new tre atments will be demonstrated most readily in older patients, while mor e intensive approaches should be rested in younger patients in whom re mission is achieved with difficulty.