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Lymphoma

Stage-specific trends in primary therapy and survival in follicular lymphoma: a nationwide population-based analysis in the Netherlands, 1989–2016

Leukemia volume 35, pages 1683–1695 (2021)Cite this article

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Abstract

We assessed stage-specific trends in primary therapy and relative survival among adult follicular lymphoma (FL) patients diagnosed in the Netherlands between 1989–2016 (N = 12,372; median age, 62 years; and 21% stage I disease). Patients were stratified by disease stage and subsequently categorized into four calendar periods (1989–1995, 1996–2002, 2003–2008, and 2009–2016) and three age groups (18–60, 61–70, and >70 years). The use of radiotherapy in stage I FL remained relatively stable over time and across the three age groups (i.e., 66%, 54%, and 49% in 2009–2016, respectively). In stage II-IV FL, the start of chemotherapy within 12 months post-diagnosis decreased over time, indicating a broader application of a watch-and-wait approach. Relative survival improved considerably over time, especially since 2003 when rituximab was introduced in the Netherlands, and for stage III-IV FL patients and older age groups. Five-year relative survival for patients with stage I-II versus stage III-IV FL in the period 2009–2016 was 96% versus 90%, 93% versus 83%, and 92% versus 68% across the three age groups, respectively. Collectively, the improvement in survival since 2003 is accounted for by advances in FL management, particularly the implementation of rituximab. There remains, however, room for improvement among elderly stage III-IV FL patients.

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Fig. 1: Incidence rates of patients with limited- and advanced-stage follicular lymphoma in the Netherlands according to sex and age at diagnosis, 1989–2016.
Fig. 2: Primary therapy of patients with limited- and advanced-stage follicular lymphoma in the Netherlands according to age at diagnosis and calendar period of diagnosis, 1989–2016.
Fig. 3: Primary therapy of patients with limited- and advanced-stage follicular lymphoma in the Netherlands according to disease stage and age at diagnosis, 2014–2016.
Fig. 4: Relative survival of patients with limited- and advanced-stage follicular lymphoma in the Netherlands, stratified by disease stage according to age at diagnosis and calendar period of diagnosis, 1989–2016.

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Acknowledgements

The authors would like to thank the registration clerks of the Netherlands Cancer Registry (NCR) for their dedicated data collection. The nationwide population-based NCR is maintained and hosted by the Netherlands Comprehensive Cancer Organisation (IKNL).

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Authors and Affiliations

  1. Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Manette A. W. Dinnessen & Avinash G. Dinmohamed

  2. Department of Internal Medicine, Division of Hematology, Maastricht University Medical Center, Maastricht, The Netherlands

    Marjolein W. M. van der Poel

  3. Department of Hematology, Cancer Center Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Sanne H. Tonino, Marie José Kersten & Avinash G. Dinmohamed

  4. Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Otto Visser

  5. Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands

    Nicole M. A. Blijlevens

  6. Amsterdam UMC, Department of Pathology, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands

    Daphne de Jong

  7. Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    King H. Lam

  8. Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Pieternella J. Lugtenburg

  9. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands

    Avinash G. Dinmohamed

  10. Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Avinash G. Dinmohamed

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Contributions

AGD and PJL designed the study; MAWD analyzed the data; OV collected the data; MAWD wrote the manuscript with contributions from all authors, who also interpreted the data, and read, commented on, and approved the final version of the manuscript.

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Correspondence to Avinash G. Dinmohamed.

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MJK has received research and travel support, as well as honoraria for presentations from Roche. The remaining authors have no conflict of interest.

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Dinnessen, M.A.W., van der Poel, M.W.M., Tonino, S.H. et al. Stage-specific trends in primary therapy and survival in follicular lymphoma: a nationwide population-based analysis in the Netherlands, 1989–2016. Leukemia 35, 1683–1695 (2021). https://doi.org/10.1038/s41375-020-01048-6

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