Minimal loss of lifetime for patients with diffuse large B-cell lymphoma in remission and event free 24 months after treatment: A Danish population-based study
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Minimal loss of lifetime for patients with diffuse large B-cell lymphoma in remission and event free 24 months after treatment : A Danish population-based study. / Jakobsen, Lasse Hjort; Bøgsted, Martin; Brown, Peter De Nully; Arboe, Bente; Jørgensen, Judit; Larsen, Thomas Stauffer; Juul, Maja Bech; Schurmann, Lene; Højberg, Linda; Bergmann, Olav Jonas; Lassen, Therese; Josefsson, Pär Lars; Jensen, Paw; Johnsen, Hans Erik; El-Galaly, Tarec Christoffer.
In: Journal of Clinical Oncology, Vol. 35, No. 7, 03.2017, p. 778-784.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Minimal loss of lifetime for patients with diffuse large B-cell lymphoma in remission and event free 24 months after treatment
T2 - A Danish population-based study
AU - Jakobsen, Lasse Hjort
AU - Bøgsted, Martin
AU - Brown, Peter De Nully
AU - Arboe, Bente
AU - Jørgensen, Judit
AU - Larsen, Thomas Stauffer
AU - Juul, Maja Bech
AU - Schurmann, Lene
AU - Højberg, Linda
AU - Bergmann, Olav Jonas
AU - Lassen, Therese
AU - Josefsson, Pär Lars
AU - Jensen, Paw
AU - Johnsen, Hans Erik
AU - El-Galaly, Tarec Christoffer
PY - 2017/3
Y1 - 2017/3
N2 - Purpose: The general outlook for patients with diffuse large B-cell lymphoma (DLBCL) in first remission is important information for patients and for planning post-treatment follow-up. The purpose of this study was to evaluate the survival of patients with DLBCL in remission compared with a matched general population. Methods: A total of 1,621 patients from the Danish Lymphoma Registry who were newly diagnosed with DLBCL between 2003 and 2011 were included in this study. All patients were ≥ 16 years of age at diagnosis and had achieved complete remission or complete remission unconfirmed after first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like therapy. Results: The 5-year post-treatment DLBCL survival was inferior to survival in the matched general population (78%; 95% CI, 76 to 80; v 87%; standardized mortality ratio, 1.75; P < .001). Excess mortality was present but reduced for patients achieving post-treatment event-free survival for 24 months (pEFS24; standardized mortality ratio, 1.27; P < .001). In age-stratified analyses, the survival of patients < 50 years of age was normalized to the general population after achieving pEFS24 (P = .99). During the first 8 years after pEFS24, the average loss of lifetime was 0.31 mo/y (95% CI, 0.11 to 0.50 mo/y). Excess mortality diminished when analyzing death from lymphoma as competing event to death from other causes, suggesting that early and late relapse is responsible for increased mortality in patients with DLBCL. Conclusion: Although this population-based study does not support complete normalization of survival for patients with DLBCL achieving pEFS24, the estimated loss of residual lifetime was low for patients in continuous remission 2 years after ending treatment. Therefore, pEFS24 is an appealing and relevant milestone for patient counseling and could be a surrogate end point in clinical trials.
AB - Purpose: The general outlook for patients with diffuse large B-cell lymphoma (DLBCL) in first remission is important information for patients and for planning post-treatment follow-up. The purpose of this study was to evaluate the survival of patients with DLBCL in remission compared with a matched general population. Methods: A total of 1,621 patients from the Danish Lymphoma Registry who were newly diagnosed with DLBCL between 2003 and 2011 were included in this study. All patients were ≥ 16 years of age at diagnosis and had achieved complete remission or complete remission unconfirmed after first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like therapy. Results: The 5-year post-treatment DLBCL survival was inferior to survival in the matched general population (78%; 95% CI, 76 to 80; v 87%; standardized mortality ratio, 1.75; P < .001). Excess mortality was present but reduced for patients achieving post-treatment event-free survival for 24 months (pEFS24; standardized mortality ratio, 1.27; P < .001). In age-stratified analyses, the survival of patients < 50 years of age was normalized to the general population after achieving pEFS24 (P = .99). During the first 8 years after pEFS24, the average loss of lifetime was 0.31 mo/y (95% CI, 0.11 to 0.50 mo/y). Excess mortality diminished when analyzing death from lymphoma as competing event to death from other causes, suggesting that early and late relapse is responsible for increased mortality in patients with DLBCL. Conclusion: Although this population-based study does not support complete normalization of survival for patients with DLBCL achieving pEFS24, the estimated loss of residual lifetime was low for patients in continuous remission 2 years after ending treatment. Therefore, pEFS24 is an appealing and relevant milestone for patient counseling and could be a surrogate end point in clinical trials.
U2 - 10.1200/JCO.2016.70.0765
DO - 10.1200/JCO.2016.70.0765
M3 - Journal article
C2 - 28095160
AN - SCOPUS:85014008148
VL - 35
SP - 778
EP - 784
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
SN - 0732-183X
IS - 7
ER -
ID: 188110416