Stage I non-Hodgkin lymphoma: no plateau in disease-specific survival ?
Stage I non-Hodgkin lymphoma (NHL) is rare; prognostic impact of different histologic subtypes and treatment modality is still unclear. We used the Surveillance, Epidemiology and End Results (SEER) database to evaluate survival outcomes among adult patients (age ≥ 18 years, N = 58,230) diagnosed with stage I NHL of various histologic subtypes between 1998 and 2014. Five-year disease-specific survival of patients with stage I diffuse large B cell lymphoma (DLBCL), follicular lymphoma (FL), marginal zone lymphoma (MZL), small lymphocytic lymphoma (SLL), Burkitt lymphoma (BL), mantle cell lymphoma (MCL), and peripheral T cell lymphoma (PTCL) was 82%, 92%, 95%, 89%, 78%, 77%, and 77%, respectively. The median disease-specific survival was not reached in all histologic subtypes analyzed; however, there does not appear to be a plateau in disease-specific survival of patients with stage I NHL irrespective of subtypes. Although lymphoma was the most common cause of death (40.7%), death from other cancer (17.4%) and cardiovascular disease (13.6%) were also frequent. Chemotherapy appeared favorably associated with OS in patients with DLBCL, BL, and MCL while patients with FL, MZL, SLL, and PTCL who require chemotherapy for initial treatment showed shorter OS. Patients with stage I NHL have favorable disease-specific survival; however, no plateau was seen regardless of histologic subtypes thus suggesting that patients may need attention and follow-up even in aggressive lymphomas after 5 years of remission.
KeywordsStage I lymphoma Disease-specific survival SEER Radiation
Compliance with ethical standards
Conflict of interest
Dr Fanale reports grants and personal consulting fees through 06/04/18 from Seattle Genetics and salary and stocks from 10/01/18 following the start of her employment with Seattle Genetics. Grants and personal fees from Takeda through 06/04/18, grants and personal fees from Celgene through 06/04/18, grants from ADC Therapeutics through 06/04/18, grants and personal fees from BMS through 06/04/18, grants and personal fees from Merck through 06/04/18, grants from Molecular Templates through 06/04/18, personal fees from Bayer through 06/04/18, personal fees from Spectrum through 06/04/18, grants from MedImmune through 06/04/18, grants from Gilead through 06/04/18, and grants from Genentech through 06/04/18.
SEER data is publically available de-identified database and thus deemed not needing approval from institutional review board.
- 1.Zhou Z, Sehn LH, Rademaker AW, Gordon LI, Lacasce AS, Crosby-Thompson A, Vanderplas A, Zelenetz AD, Abel GA, Rodriguez MA, Nademanee A, Kaminski MS, Czuczman MS, Millenson M, Niland J, Gascoyne RD, Connors JM, Friedberg JW, Winter JN (2014) An enhanced international prognostic index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood 123(6):837–842. https://doi.org/10.1182/blood-2013-09-524108 CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Miller TP, Dahlberg S, Cassady JR, Adelstein DJ, Spier CM, Grogan TM, LeBlanc M, Carlin S, Chase E, Fisher RI (1998) Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma. N Engl J Med 339(1):21–26. https://doi.org/10.1056/NEJM199807023390104 CrossRefPubMedGoogle Scholar
- 3.Shenkier TN, Voss N, Fairey R, Gascoyne RD, Hoskins P, Klasa R, Klimo P, O'Reilly SE, Sutcliffe S, Connors JM (2002) Brief chemotherapy and involved-region irradiation for limited-stage diffuse large-cell lymphoma: an 18-year experience from the British Columbia Cancer Agency. J Clin Oncol 20(1):197–204. https://doi.org/10.1200/JCO.2002.20.1.197 CrossRefPubMedGoogle Scholar
- 4.Stephens DM, Li H, LeBlanc ML, Puvvada SD, Persky D, Friedberg JW, Smith SM (2016) Continued risk of relapse independent of treatment modality in limited-stage diffuse large B-cell lymphoma: final and long-term analysis of southwest oncology group study S8736. J Clin Oncol 34(25):2997–3004. https://doi.org/10.1200/JCO.2015.65.4582 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.National Comprehensive Cancer Network. (2018) B-cell lymphomas (version 5.2018). https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf
- 10.Chihara D, Oki Y, Fanale MA, Westin JR, Nastoupil LJ, Neelapu S, Fayad L, Fowler NH, Cheah CY (2018) Stage I non-Hodgkin lymphoma: difference in survival outcome by primary extranodal site of involvement. Br J Haematol doi: https://doi.org/10.1111/bjh.15444
- 11.Suzuki R, Chihara D, Asano N, Ohmachi K, Kinoshita T, Matsue K, Suzumiya J, Ogura M (2016) Limited-stage mantle cell lymphoma. Blood 128(22):5330–5330Google Scholar
- 12.Romaguera JE, Medeiros LJ, Hagemeister FB, Fayad LE, Rodriguez MA, Pro B, Younes A, McLaughlin P, Goy A, Sarris AH, Dang NH, Samaniego F, Brown HM, Gagneja HK, Cabanillas F (2003) Frequency of gastrointestinal involvement and its clinical significance in mantle cell lymphoma. Cancer 97(3):586–591. https://doi.org/10.1002/cncr.11096 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Phan J, Mazloom A, Medeiros LJ, Zreik TG, Wogan C, Shihadeh F, Rodriguez MA, Fayad L, Fowler N, Reed V, Horace P, Dabaja BS (2010) Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy. J Clin Oncol 28(27):4170–4176. https://doi.org/10.1200/JCO.2009.27.3441 CrossRefPubMedGoogle Scholar
- 14.Lamy T, Damaj G, Soubeyran P, Gyan E, Cartron G, Bouabdallah K, Gressin R, Cornillon J, Banos A, Le Du K, Benchalal M, Moles MP, Le Gouill S, Fleury J, Godmer P, Maisonneuve H, Deconinck E, Houot R, Laribi K, Marolleau JP, Tournilhac O, Branger B, Devillers A, Vuilliez JP, Fest T, Colombat P, Costes V, Szablewski V, Bene MC, Delwail V (2017) R-CHOP 14 with or without radiotherapy in non-bulky limited-stage diffuse large B-cell lymphoma (DLBCL). Blood 131:174–181. https://doi.org/10.1182/blood-2017-07-793984 CrossRefPubMedGoogle Scholar
- 15.Shah GD, Yahalom J, Correa DD, Lai RK, Raizer JJ, Schiff D, LaRocca R, Grant B, DeAngelis LM, Abrey LE (2007) Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol 25(30):4730–4735. https://doi.org/10.1200/jco.2007.12.5062 CrossRefPubMedGoogle Scholar
- 16.Vitolo U, Chiappella A, Ferreri AJ, Martelli M, Baldi I, Balzarotti M, Bottelli C, Conconi A, Gomez H, Lopez-Guillermo A, Martinelli G, Merli F, Novero D, Orsucci L, Pavone V, Ricardi U, Storti S, Gospodarowicz MK, Cavalli F, Sarris AH, Zucca E (2011) First-line treatment for primary testicular diffuse large B-cell lymphoma with rituximab-CHOP, CNS prophylaxis, and contralateral testis irradiation: final results of an international phase II trial. J Clin Oncol 29(20):2766–2772. https://doi.org/10.1200/JCO.2010.31.4187 CrossRefPubMedGoogle Scholar
- 18.Macmanus MP, Fisher R, Roos D, O'Brien P, Macann A, Tsang R, Davis S, Christie D, McClure B, Joseph D, Seymour JF (2017) CVP or R-CVP given after involved-field radiotherapy improves progression free survival in stage I–II follicular lymphoma: results of an international randomized trial. Hematol Oncol 35:31–31. https://doi.org/10.1002/hon.2437_11 CrossRefGoogle Scholar
- 19.Clarke CA, Undurraga DM, Harasty PJ, Glaser SL, Morton LM, Holly EA (2006) Changes in cancer registry coding for lymphoma subtypes: reliability over time and relevance for surveillance and study. Cancer Epidemiol Biomark Prev 15(4):630–638. https://doi.org/10.1158/1055-9965.EPI-05-0549 CrossRefGoogle Scholar