Outcome of advanced stage low grade follicular lymphomas in a population-based retrospective cohort

BACKGROUND. To the authors' knowledge previous reports of patient outcome f or advanced stage low grade follicular lymphomas (LGFL) have not been popul ation-based. This is the first report describing the outcome of these patie nts based on a population-based cohort. METHODS. A retrospective chart review was performed for all patients diagno sed with advanced stage LGFL between 1987-1995 for the adult population of central and northern Alberta, Canada. RESULTS. One hundred and fifty-seven patients were diagnosed with advanced stage LGFL. Approximately 45% of patients had died at last follow-up. Treat ment was initiated at the time of diagnosis in 87 patients (55%), with alky lating agents used in 66% of them. Of the 70 patients not treated at the in itial diagnosis, 69% had been treated at a median of 16.3 months. The overa ll median survival was 5.9 years. On univariate analysis, significant varia bles (P < 0.20) included age, B symptoms, symptomatic lymphadenopathy, symp tomatic splenomegaly, splenomegaly, Eastern Cooperative Oncology Group perf ormance status, baseline lactate dehydrogenase (LDH), diffuse component on histology, and treatment at the time of diagnosis. By multivariate analysis , the only factors that influenced survival significantly and independently were baseline LDH and B symptoms. An elevated baseline LDH had a hazard ra tio of 2.80 (95% confidence interval [CI], 1.65, 4.74) and a median surviva l of 8.0 years versus 3.6 years (P < 0.0001). B symptoms had a hazard ratio of 2.30 (95% CI, 1.23, 4.30) and a median survival of 6.5 years versus 3.1 years (P < 0.0067). CONCLUSIONS. Although some patients with advanced stage LGFL enjoy a prolon ged survival, 80% of deaths in this cohort were attributable to lymphoma. T he median overall survival of 5.9 years offers a less positive perspective on the outcome of these patients than in previous nonpopulation-based repor ts. This emphasizes the need for further population-based studies as well a s new therapeutic approaches, especially those directed toward patients wit h poor prognostic features such as elevated baseline LDH and B symptoms. Ca ncer 1999;85:1361-8. (C) 1999 American Cancer Society.