Non-Hodgkin Lymphoma Survival Has Increased Over Past Decade

Zosia Chustecka

March 11, 2008

March 11, 2008 — Survival rates for non-Hodgkin lymphoma (NHL) have improved over the past decade, and the prognosis for patients has "strongly improved" during the 1990s and beyond, concludes a new review.

The review appears in the March 10 issue of the Archives of Internal Medicine, and was carried out by Dianne Pulte, MD, and colleagues at the German Cancer Research Center in Heidelberg. They used data from the Surveillance, Epidemiology and End Results (SEER) program to show how survival rates have increased in recent years. Between 1990 and 2004, 5-year relative survival for NHL patients has increased from 50.4% to 66.8% and 10-year relative survival has increased from 39.4% to 56.3%.

The improvement in outlook is probably due to 2 factors, the authors comment. One is the advance in therapy that has occurred, in particular the introduction of antibody therapy with rituximab (Rituxan/MabThera, Roche). First approved to treat NHL in the United States in 1997, rituximab used with chemotherapy has extended life expectancy in many cases, although "whether and how often this extension represents a true cure is still unknown," they add. Rituximab with chemotherapy has shown higher response rates than chemotherapy alone, and "our data suggest that these improved results from clinical trials have translated into better survival on a population level," they comment.

The other factor probably contributing to the improved outlook is the decrease that has been seen in recent years in the number of cases of NHL related to human immunodeficiency virus (HIV), first observed in the early 1980s. This has resulted from an improvement in the treatment of HIV, particularly with highly active antiretroviral therapy (HAART) developed in the late 1990s. HIV that is well controlled with HAART rarely leads to lymphomas, and the rate of NHL associated with HIV fell in the late 1990s, the authors comment.

Improvements in prognosis were seen in all age groups, in both sexes, in nodal and extranodal disease, and in low- and high-grade disease, Dr. Pulte and colleagues comment. The most pronounced improvements were seen in patients younger than 45 years of age, they add. One area of concern, however, is the large racial difference observed — the improvement in survival was smaller for black than for white patients, especially younger black patients. The difference was "large and the gap increased over time, except for patients 75 years or older," they note.

In contrast to the situation seen with many other hematologic malignant neoplasms, the improvement in NHL survival was also seen in the elderly, the authors comment. Ritiximab plus chemotherapy has been shown to be safe and effective in elderly patients in clinical trials, they note, and this might have resulted in clinicians having "a higher comfort level" in prescribing this combination to elderly patients, compared with some of the more aggressive treatments needed to produce remission in other hematologic cancers. "Nonetheless, approximately 42% of patients with NHL diagnosed between 1992 and 1999 who were 75 years and older did not receive any specific treatment for their disease, suggesting that there is room for improvement in the treatment of this age group," they conclude.

The researchers have disclosed no relevant financial relationships.

Arch Intern Med. 2008;168:469-476.

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