Blood cancers

Lymphoma survival rates improved in rituximab era

The first major improvements in B-cell non-Hodgkin lymphoma survival rates since the 1970s occurred following the introduction of rituximab, Australian research shows.

A study of outcomes for lymphoma in Queensland patients over the last two decades found there were increases in overall survival rates of around 13% for the two most common subtypes, diffuse large B-cell lymphoma and follicular (DLBCL) and follicular lymphoma following the listing of rituximab on the PBS for first line therapy after 2003.

However there was no change in survival rates for  patients with Hodgkin lymphoma over the same period.

The findings, from a retrospective analysis of outcomes for 9509 diagnosed with lymphoma in Queensland during the 1993-2012 period also found an inferior survival rate (Hazard Ration 1.14) for rural residents with DLBCL but not other lymphoma subtypes.

Published in the MJA, the analysis found that five-year relative survival rates for DLBCL improved from 47% to 67% between 1993-1997 and 2008-2012. Likewise there was an improvement in relative survival rates for follicular lymphoma from 62% to 88%.

There was also improvement in relative survival rates for highly aggressive lymphoma, from 24% to 58%, which coincided with the widespread uptake of brief high-intensity chemotherapy regimens.

Relative survival rates for Hodgkin lymphoma remained unchanged at around 81%, and survival rates for peripheral T-cell lymphomas declined from 45% to 37%, with the study authors noting that these outcomes preceded the introduction of novel agents such as brentuximab vedotin and PD1 inhibitors.

The study authors said the improvements in survival for the two most common lymphoma subtypes (which accounted for 74% of all lymphoma cases)  were the first major improvements in outcomes seen since the introduction of CHOP chemotherapy in the 1970s.

“Conversely, the outcomes of CHOP chemotherapy for patients with PTCL are still poor, and this indicates an unmet medical need,” wrote the authors, led by Dr Fraser Wright, a haematologist at the Royal Brisbane and Women’s Hospital.

The findings of lower survival for some rural patients with lymphoma suggested that patients  in these areas should receive assistance in travel to tertiary referral centres, they added.

“Given the geographic size of Australia and the relatively favourable outcomes for patients with most lymphoma subtypes compared with those for patients with solid cancers, it is important that all treating medical practitioners be aware of the benefits of coordinated care in the tertiary setting for rural patients,” they said.

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