James E. Wooldridge

Improved Survival of Follicular Lymphoma Patients in the United States

PURPOSEnDespite several new treatment options, single- and multi-institution analyses have not clarified whether survival patterns in follicular lymphoma (FL) patients have changed in recent decades. We undertook a study using a large population-based registry to analyze survival patterns among patients with FL.nnnPATIENTS AND METHODSnSurveillance, Epidemiology, and End Results morphology codes were used to identify 14,564 patients diagnosed with FL between 1978 and 1999. Observed median survival times, Kaplan-Meier survival curves, proportional death hazard ratios, and relative survival rates were calculated. Joinpoint regression analysis was used to identify trends in annual adjusted death hazard ratios.nnnRESULTSnAn improvement in survival of all patients with FL was observed between each of three diagnosis eras (1978 to 1985, 1986 to 1992, and 1993 to 1999) by log-rank tests. Among patients with stage-specific data, the median survival time improved from 84 months (95% CI, 81 to 88 months) in the 1983 to 1989 era to 93 months (95% CI, 89 to 97 months) in the 1993 to 1999 era. Similar findings were identified across sex and age groups and for subsets including advanced-stage, large-cell FL and the combined subset of small cleaved- and mixed-cell FL. The inter-era survival advantage observed in white patients was not observed for black patients. The relative risk of death decreased by 1.8% per year over the 1983 to 1999 observation period.nnnCONCLUSIONnThe survival of patients with FL in the United States has improved over the last 25 years. The survival improvement may be a result of the sequential application of effective therapies and improved supportive care.

Neutropenia and febrile neutropenia in patients with Hodgkin's lymphoma treated with doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy

When uncomplicated neutropenia during doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine (ABVD) chemoterapy for the treatment of Hodgkins lymphoma is encountered, it is unclear whether or not treatment should be modified. In the present study, we determined the incidence of neutropenia, febrile neutropenia, and the relationship of febrile neutropenia to grade III/IV neutropenia and dose modification, in a large university patient population. We reviewed the charts of patients diagnosed with Hodgkins lymphoma between 1 January 1990 and 31 December 2002 who were treated with ABVD chemotherapy, and seen at the University of Iowa with complete diagnosis, staging, and treatment dosing records. Adequate data was available on 894 treatments in 81 patients with Hodgkins lymphoma treated with ABVD chemotherapy. Grade III/IV neutropenia was present on the scheduled day of treatment in 187 (20.9%) treatments in 64 (79%) patients. Grade III/IV neutropenia was most common at cycle 1 day 15. Febrile neutropenia developed nine times in eight patients, and eight episodes of febrile neutropenia developed when the treatment-day absolute neutrophil count (ANC) ⩾1000. Dose delay of >4 days and/or dose reduction to <80% of original doxorubicin dose following grade III/IV neutropenia occurred in 29 of 187 treatments, with no episodes of febrile neutropenia. With grade III/IV neutropenia on the day of therapy, 158 treatments were administered without dose reduction or dose delay with one subsequent episode of febrile neutropenia. Neutropenia during ABVD is common, and dose modification for uncomplicated neutropenia on the day of treatment may not reduce the risk of febrile neutropenia. It may be possible to maintain dose intensity in the face of uncomplicated neutropenia during ABVD therapy.

Optic neuropathy due to anaplastic large cell lymphoma

Purpose. To report a case of anaplastic large cell lymphoma (ALCL) of the central nervous system (CNS) producing an optic neuropathy. Methods. Observational case report. Results. A 29-year-old male presented with new onset headaches. Magnetic resonance imaging (MRI) of the brain revealed a large enhancing parietal lobe mass. Ocular exam at that time was normal. Initial diagnoses included possible bacterial cerebritis and fungal abscess. Serial lumbar punctures showed increased white blood cells but cytology was negative. A brain biopsy was non-diagnostic. The patient then presented with a left optic neuropathy. Repeat MRI of the brain and orbits revealed infiltration of the clivus and left orbital apex including the optic nerve. The patient had elevated liver function studies and an abdominal ultrasound disclosed two hypoechoic lesions. Liver biopsy confirmed the diagnosis of ALK-1 positive ALCL. The patient was treated with chemotherapy but expired seven months after the initial presentation. Conclusion. ALCL should be considered to be a very rare but potential cause of optic neuropathy. To our knowledge, this is the first reported case of ALCL causing an optic neuropathy.

Improved survival of follicular lymphoma patients in the surveillance, epidemiology, and end-results (SEER) program.

6578 Background: Follicular lymphomas (FL) comprise 17% of non-Hodgkin lymphoma cases in the United States. Several single- and multi-institution groups have published analyses of long-term follow-up of FL patients, yet it remains unclear whether survival patterns in FL have changed over the past twenty years.nnnMETHODSnUsing data provided in the National Cancer Institutes SEER program, 12,088 patients with FL were identified by ICD-O-2 diagnostic codes: grade I (9693-9696), grade II (9691-9692), grade III (9697-9698), grade NOS (9690). Observed median survival curves and proportional death hazard ratios were calculated from Cox regression analysis using SAS version 8.2. SEER*Stat 5.0 was used to calculate relative survival rates where expected survival rates were based on mortality rates for the entire U.S.nnnPOPULATIONnSurvival probabilities were calculated accounting for diagnosis era (1983-89, 1990-99), age at diagnosis, gender, race, and tumor grade at diagnosis.nnnRESULTSnCompared with FL patients diagnosed in the 1990-1999 era, those diagnosed in the 1983-1989 era had statistically elevated death hazard ratios. These findings were consistent among subsets including advanced stage (III and IV), grade I and grade III, male, female, and patients under and over age 60. Survival trends demonstrated analogous findings across eras when calculated using relative median survival rates.nnnCONCLUSIONSnOverall survival for FL has improved over the past 20 years, perhaps related to changes in management. This improvement is noted broadly across subsets evaluated including advanced stage, divergent age groups and at extremes of grade classification. [Figure: see text] No significant financial relationships to disclose.