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Age and comorbidity are determining factors in the overall and relative survival of patients with follicular lymphoma

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Abstract

Frailty and concurrent medical conditions are crucial factors in the management of follicular lymphoma (FL). We evaluated the impact of age and comorbidity on survival, causes of death, histological transformation (HT), and second malignancies (SM) in a large single-center series of grade 1–3A FL. We studied 414 patients diagnosed in the rituximab era, categorized into three age groups (≤60, 61–70, >70 years) and two comorbidity groups (Charlson Comorbidity Index, CCI, 0–1 and ≥2). Despite a similar cumulative incidence of relapse, older and comorbid patients had a lower 10-year overall survival (OS, 88, 65, and 41% for patients ≤60 years, 61–70 years, and >70 years, P<0.0001; and 76 vs. 51% for CCI 0–1 and ≥2, P<0.0001). In a multivariate analysis for OS, comorbidity retained its prognostic impact (HR=2.5, P=0.0003). The proportion of patients dying due to FL was higher among those ≤60 years (74%) and those with a CCI 0–1 (67%). Furthermore, 10-year excess mortality (survival reduction) was more prominent for patients >70 years (30%) and those with a CCI ≥2 (32%). Patients with a CCI ≥2 also had a higher incidence of SM. These data encourage a comprehensive pre-treatment evaluation and a tailored therapeutic approach for all FL patients.

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Funding

This study was supported by “Becas de Investigación de la FEHH” (Fundación Española de Hematología y Hemoterapia) to PM, the PI19/00925 grant (Instituto de Salud Carlos III) to LM, and the PI19/00887 grant (Instituto de Salud Carlos III) to ALG and EG.

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Author notes

  1. Tycho Baumann

    Present address: Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain

  2. Laura Magnano and Armando López-Guillermo are equally contributing senior authors.

Authors and Affiliations

  1. Department of Hematology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain

    Pablo Mozas, Andrea Rivero, Alfredo Rivas-Delgado, Juan Gonzalo Correa, Carlos Castillo, Alex Bataller, Tycho Baumann, Eva Giné, Julio Delgado, Laura Magnano & Armando López-Guillermo

  2. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Ferran Nadeu, Eva Giné, Julio Delgado, Neus Villamor, Elías Campo, Laura Magnano & Armando López-Guillermo

  3. Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain

    Ferran Nadeu, Eva Giné, Julio Delgado, Neus Villamor, Elías Campo, Laura Magnano & Armando López-Guillermo

  4. Hematopathology Unit, Department of Pathology, Hospital Clínic, Barcelona, Spain

    Neus Villamor & Elías Campo

  5. University of Barcelona, Barcelona, Spain

    Elías Campo & Armando López-Guillermo

Authors
  1. Pablo Mozas
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Contributions

PM designed the study, collected the data, performed the analysis, and wrote the paper. AR, ARD, FN, JGC, CC, AB, TB, EG, JD, NV, EC, LM, and ALG contributed to data collection and approved the final version of the manuscript.

Corresponding author

Correspondence to Pablo Mozas.

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The study was conducted according to the Hospital Clínic Institutional Review Board and in accordance with the Declaration of Helsinki.

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The authors declare no competing interests.

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Mozas, P., Rivero, A., Rivas-Delgado, A. et al. Age and comorbidity are determining factors in the overall and relative survival of patients with follicular lymphoma. Ann Hematol 100, 1231–1239 (2021). https://doi.org/10.1007/s00277-021-04470-7

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  • DOI: https://doi.org/10.1007/s00277-021-04470-7

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