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Article ; Online: Stable use of radiotherapy in lymphoma patients over time - A comprehensive national overview of radiotherapy use in Sweden with focus on older patients.

Glimelius, Ingrid / Ekberg, Sara / Ekström Smedby, Karin / Wästerlid, Tove

Clinical and translational radiation oncology

2024 Volume 46, Page(s) 100785

Abstract: Background and purpose: The role of radiotherapy (RT) in lymphoma is constantly refined with the advent of novel treatments. However, RT is still an effective treatment and tolerability is high. Therefore, we aimed to describe the use of RT in primary ... ...

Abstract	Background and purpose: The role of radiotherapy (RT) in lymphoma is constantly refined with the advent of novel treatments. However, RT is still an effective treatment and tolerability is high. Therefore, we aimed to describe the use of RT in primary treatment of lymphoma over calendar time, with a specific focus on older patients (age ≥ 70 years) with non-Hodgkin lymphoma (NHL) subtypes. Materials & methods: All adult patients diagnosed with lymphoma from 2007 to 2018 in Sweden were included and followed for survival until end of 2020. Patient characteristics and relative survival (RS) were described for patients with NHL by subtype and RT use. Results: In the cohort of lymphoma patients aged ≥ 70 years (n = 12,698) 11 % received RT as part of primary treatment. No decline in use of RT over calendar period was seen. Use of RT as monotherapy was associated with stage I-II disease and older age among patients with stage III-IV disease. Patients with indolent lymphomas aged ≥ 70 years who were selected for treatment with RT as monotherapy with a dose of ≥ 20 Gy had 2-year RS rate of 100 % which remained similar at five years. For patients with DLBCL, RT as monotherapy with a dose of ≥ 20 Gy was mostly administered to patients aged ≥ 85 years with a 2-year RS rate of 68 %. Conclusion: The use of RT in first-line lymphoma treatment was stable over calendar time. RT monotherapy is associated with encouraging outcomes among patients with NHL aged ≥ 70 years who were selected to receive this.
Language	English
Publishing date	2024-04-21
Publishing country	Ireland
Document type	Journal Article
ISSN	2405-6308
ISSN (online)	2405-6308
DOI	10.1016/j.ctro.2024.100785
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Article ; Online: Standardised survival probabilities: a useful and informative tool for reporting regression models for survival data.

Syriopoulou, Elisavet / Wästerlid, Tove / Lambert, Paul C / Andersson, Therese M-L

British journal of cancer

2022 Volume 127, Issue 10, Page(s) 1808–1815

Abstract: Background: When interested in studying the effect of a treatment (or other exposure) on a time-to-event outcome, the most popular approach is to estimate survival probabilities using the Kaplan-Meier estimator. In the presence of confounding, ... ...

Abstract	Background: When interested in studying the effect of a treatment (or other exposure) on a time-to-event outcome, the most popular approach is to estimate survival probabilities using the Kaplan-Meier estimator. In the presence of confounding, regression models are fitted, and results are often summarised as hazard ratios. However, despite their broad use, hazard ratios are frequently misinterpreted as relative risks instead of relative rates. Methods: We discuss measures for summarising the analysis from a regression model that overcome some of the limitations associated with hazard ratios. Such measures are the standardised survival probabilities for treated and untreated: survival probabilities if everyone in the population received treatment and if everyone did not. The difference between treatment arms can be calculated to provide a measure for the treatment effect. Results: Using publicly available data on breast cancer, we demonstrated the usefulness of standardised survival probabilities for comparing the experience between treated and untreated after adjusting for confounding. We also showed that additional important research questions can be addressed by standardising among subgroups of the total population. Discussion: Standardised survival probabilities are a useful way to report the treatment effect while adjusting for confounding and have an informative interpretation in terms of risk.
MeSH term(s)	Humans ; Female ; Survival Analysis ; Proportional Hazards Models ; Probability ; Breast Neoplasms/therapy ; Risk
Language	English
Publishing date	2022-09-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80075-2
ISSN	1532-1827 ; 0007-0920
ISSN (online)	1532-1827
ISSN	0007-0920
DOI	10.1038/s41416-022-01949-6
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Article ; Online: Impact of the COVID-19 pandemic on lymphoma incidence and short-term survival - a Swedish Lymphoma Register Study.

Ekberg, Sara / Molin, Daniel / Pahnke, Simon / Bergström, Fanny / Brånvall, Elsa / Smedby, Karin E / Wästerlid, Tove

Acta oncologica (Stockholm, Sweden)

2024 Volume 63, Page(s) 164–168

Abstract: Background & purpose: The COVID-19 pandemic posed a large challenge for healthcare systems across the world. Comprehensive data on the impact of the COVID-19 pandemic on incidence and mortality in lymphoma are lacking.: Patients/methods: Using data ... ...

Abstract	Background & purpose: The COVID-19 pandemic posed a large challenge for healthcare systems across the world. Comprehensive data on the impact of the COVID-19 pandemic on incidence and mortality in lymphoma are lacking. Patients/methods: Using data from the Swedish lymphoma register, we compare incidence and 1-year survival of lymphoma patients in Sweden before (2017-2019) and during the pandemic (2020 and 2021). Results: Fewer patients were diagnosed with lymphomas during March-June 2020, but the annual incidence rates for 2020 and 2021 were similar to those of 2017-2019. A larger proportion of patients presented with stage IV disease during 2021. There were no differences in other base-line characteristics nor application of active treatment in pre-pandemic and pandemic years. One-year overall survival was not inferior among lymphoma patients during the pandemic years compared to pre-pandemic years i.e., 2017-2019. Interpretation: The COVID-19 pandemic had limited impact on the incidence and mortality of lymphoma in Sweden.
MeSH term(s)	Humans ; Incidence ; Sweden/epidemiology ; Pandemics ; COVID-19/epidemiology ; Lymphoma/epidemiology ; Lymphoma/pathology
Language	English
Publishing date	2024-04-09
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	896449-x
ISSN	1651-226X ; 0349-652X ; 0284-186X ; 1100-1704
ISSN (online)	1651-226X
ISSN	0349-652X ; 0284-186X ; 1100-1704
DOI	10.2340/1651-226X.2024.35238
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Article ; Online: Statin use and survival in 16 098 patients with non-Hodgkin lymphoma or chronic lymphocytic leukaemia treated in the rituximab era.

Brånvall, Elsa / Ekberg, Sara / Eloranta, Sandra / Wästerlid, Tove / Birmann, Brenda M / Smedby, Karin E

British journal of haematology

2021 Volume 195, Issue 4, Page(s) 552–560

Abstract: Statin use has been associated with reduced mortality from several cancers but also suggested, in vitro, to diminish the effectiveness of lymphoma treatments including rituximab. The present study aimed to assess the association of statin use with ... ...

Abstract	Statin use has been associated with reduced mortality from several cancers but also suggested, in vitro, to diminish the effectiveness of lymphoma treatments including rituximab. The present study aimed to assess the association of statin use with mortality in patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukaemia (CLL). We identified all incident NHLs and CLLs in Sweden from 2007 to 2013 with subtype information in the Swedish Lymphoma and Cancer Registers. Using Cox regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of pre- or post-diagnosis statin use (yes/no, intensity) with lymphoma-specific, cardiovascular, or all-cause mortality; and for follicular lymphoma (FL) by initial treatment strategy (active/watch-and-wait). Among 16 098 incident NHL/CLL patients, 20% used statins at diagnosis. Pre- and post-diagnosis statin use, and statin intensity were not consistently associated with any mortality outcome in patients with NHL, overall or for any subtype. For actively treated patients with FL, statin use did not appear to increase lymphoma-specific mortality (vs. non-users, HR [95% CI]
MeSH term(s)	Aged ; Aged, 80 and over ; Cardiovascular Diseases/mortality ; Case-Control Studies ; Cause of Death ; Comorbidity ; Dose-Response Relationship, Drug ; Female ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy ; Leukemia, Lymphocytic, Chronic, B-Cell/mortality ; Lymphoma, Follicular/drug therapy ; Lymphoma, Follicular/mortality ; Lymphoma, Non-Hodgkin/drug therapy ; Lymphoma, Non-Hodgkin/mortality ; Male ; Middle Aged ; Mortality ; Proportional Hazards Models ; Registries ; Rituximab/therapeutic use ; Survival Analysis ; Sweden/epidemiology
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Rituximab (4F4X42SYQ6)
Language	English
Publishing date	2021-07-31
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80077-6
ISSN	1365-2141 ; 0007-1048
ISSN (online)	1365-2141
ISSN	0007-1048
DOI	10.1111/bjh.17733
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Article ; Online: Application of precision medicine in clinical routine in haematology-Challenges and opportunities.

Wästerlid, Tove / Cavelier, Lucia / Haferlach, Claudia / Konopleva, Marina / Fröhling, Stefan / Östling, Päivi / Bullinger, Lars / Fioretos, Thoas / Smedby, Karin E

Journal of internal medicine

2022 Volume 292, Issue 2, Page(s) 243–261

Abstract: Precision medicine is revolutionising patient care in cancer. As more knowledge is gained about the impact of specific genetic lesions on diagnosis, prognosis and treatment response, diagnostic precision and the possibility for optimal individual ... ...

Abstract	Precision medicine is revolutionising patient care in cancer. As more knowledge is gained about the impact of specific genetic lesions on diagnosis, prognosis and treatment response, diagnostic precision and the possibility for optimal individual treatment choice have improved. Identification of hallmark genetic aberrations such as the BCR::ABL1 gene fusion in chronic myeloid leukaemia (CML) led to the rapid development of efficient targeted therapy and molecular follow-up, vastly improving survival for patients with CML during recent decades. The assessment of translocations, copy number changes and point mutations are crucial for the diagnosis and risk stratification of acute myeloid leukaemia and myelodysplastic syndromes. Still, the often heterogeneous and complex genetic landscape of haematological malignancies presents several challenges for the implementation of precision medicine to guide diagnosis, prognosis and treatment choice. This review provides an introduction and overview of the important molecular characteristics and methods currently applied in clinical practice to guide clinical decision making in haematological malignancies of myeloid and lymphoid origin. Further, experimental ways to guide the choice of targeted therapy for refractory patients are reviewed, such as functional precision medicine using drug profiling. An example of the use of pipeline studies where the treatment is chosen according to the molecular characteristics in rare solid malignancies is also provided. Finally, the future opportunities and remaining challenges of precision medicine in the real world are discussed.
MeSH term(s)	Fusion Proteins, bcr-abl/genetics ; Fusion Proteins, bcr-abl/therapeutic use ; Hematologic Neoplasms/diagnosis ; Hematologic Neoplasms/genetics ; Hematologic Neoplasms/therapy ; Hematology ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy ; Leukemia, Myeloid, Acute/therapy ; Precision Medicine
Chemical Substances	Fusion Proteins, bcr-abl (EC 2.7.10.2)
Language	English
Publishing date	2022-06-04
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	96274-0
ISSN	1365-2796 ; 0954-6820
ISSN (online)	1365-2796
ISSN	0954-6820
DOI	10.1111/joim.13508
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Article: Data-driven support to decision-making in molecular tumour boards for lymphoma: A design science approach.

Rodríguez Ruiz, Núria / Abd Own, Sulaf / Ekström Smedby, Karin / Eloranta, Sandra / Koch, Sabine / Wästerlid, Tove / Krstic, Aleksandra / Boman, Magnus

Frontiers in oncology

2022 Volume 12, Page(s) 984021

Abstract: Background: The increasing amount of molecular data and knowledge about genomic alterations from next-generation sequencing processes together allow for a greater understanding of individual patients, thereby advancing precision medicine. Molecular ... ...

Abstract	Background: The increasing amount of molecular data and knowledge about genomic alterations from next-generation sequencing processes together allow for a greater understanding of individual patients, thereby advancing precision medicine. Molecular tumour boards feature multidisciplinary teams of clinical experts who meet to discuss complex individual cancer cases. Preparing the meetings is a manual and time-consuming process. Purpose: To design a clinical decision support system to improve the multimodal data interpretation in molecular tumour board meetings for lymphoma patients at Karolinska University Hospital, Stockholm, Sweden. We investigated user needs and system requirements, explored the employment of artificial intelligence, and evaluated the proposed design with primary stakeholders. Methods: Design science methodology was used to form and evaluate the proposed artefact. Requirements elicitation was done through a scoping review followed by five semi-structured interviews. We used UML Use Case diagrams to model user interaction and UML Activity diagrams to inform the proposed flow of control in the system. Additionally, we modelled the current and future workflow for MTB meetings and its proposed machine learning pipeline. Interactive sessions with end-users validated the initial requirements based on a fictive patient scenario which helped further refine the system. Results: The analysis showed that an interactive secure Web-based information system supporting the preparation of the meeting, multidisciplinary discussions, and clinical decision-making could address the identified requirements. Integrating artificial intelligence Impact: Our work is of methodological importance in that using artificial intelligence for molecular tumour boards is novel. We provide a consolidated proof-of-concept system that could support the end-to-end clinical decision-making process and positively and immediately impact patients. Conclusion: Augmenting a digital decision support system for molecular tumour boards with retrospective patient material is promising. This generates realistic and constructive material for human learning, and also digital data for continual learning by data-driven artificial intelligence approaches. The latter makes the future system adaptable to human bias, improving adequacy and decision quality over time and over tasks, while building and maintaining a digital log.
Language	English
Publishing date	2022-11-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.984021
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Article ; Online: Incidence and time trends of second primary malignancies after non-Hodgkin lymphoma: a Swedish population-based study.

Joelsson, Joel / Wästerlid, Tove / Rosenquist, Richard / Jakobsen, Lasse Hjort / El-Galaly, Tarec C / Smedby, Karin E / Eloranta, Sandra

Blood advances

2022 Volume 6, Issue 8, Page(s) 2657–2666

Abstract: Considering treatment changes and an improved prognosis of non-Hodgkin lymphoma (NHL) over time, knowledge regarding long-term health outcomes, including late effects of treatment, has become increasingly important. We report on time trends of second ... ...

Abstract	Considering treatment changes and an improved prognosis of non-Hodgkin lymphoma (NHL) over time, knowledge regarding long-term health outcomes, including late effects of treatment, has become increasingly important. We report on time trends of second primary malignancies (SPMs) in Swedish NHL patients, encompassing the years before as well as after the introduction of anti-CD20 antibody therapy. We identified NHL patients in the Swedish Cancer Register 1993 to 2014 and matched comparators from the Swedish Total Population Register. The matched cohort was followed through 2017. By linking to the Swedish Lymphoma Register, subcohort analyses by NHL subtype were performed. Flexible parametric survival models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of SPM among patients and comparators. Among 32 100 NHL patients, 3619 solid tumors and 217 myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) cases were observed, corresponding to a 40% higher rate of solid tumors (HRsolid tumors = 1.4; 95% CI, 1.4-1.5) and a 5-fold higher rate of MDS/AML (HRMDS/AML = 5.2; 95% CI, 4.4-6.2) than for comparators. Overall, the observed excess risks for solid tumors or MDS/AML remained stable over the study period, except for follicular lymphoma, where the excess rate of MDS/AML attenuated with time (P for trend = .012). We conclude that NHL survivors have an increased risk of both solid tumors and hematologic malignancies, in particular MDS/AML. Stable excess risks over time indicate that contemporary treatment standards are not associated with modified SPM risk. Encouragingly, decreasing rates of MDS/AML were noted among patients with follicular lymphoma, possibly due to the increasing use of nonchemotherapy-based treatments.
MeSH term(s)	Humans ; Incidence ; Leukemia, Myeloid, Acute/etiology ; Lymphoma, Follicular/epidemiology ; Lymphoma, Non-Hodgkin ; Myelodysplastic Syndromes/epidemiology ; Neoplasms, Second Primary/epidemiology ; Neoplasms, Second Primary/etiology ; Sweden/epidemiology
Language	English
Publishing date	2022-01-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2915908-8
ISSN	2473-9537 ; 2473-9529
ISSN (online)	2473-9537
ISSN	2473-9529
DOI	10.1182/bloodadvances.2021006369
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Zs.A 7153: Show issues

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Article ; Online: Statin use is associated with improved survival in multiple myeloma: A Swedish population-based study of 4315 patients.

Brånvall, Elsa / Ekberg, Sara / Eloranta, Sandra / Wästerlid, Tove / Birmann, Brenda M / Smedby, Karin E

American journal of hematology

2020 Volume 95, Issue 6, Page(s) 652–661

Abstract: Statin use has been associated with reduced cancer-specific mortality among patients with several cancer types, including multiple myeloma (MM). We aimed to further elucidate the association of statin use and dose intensity with MM survival. Using ... ...

Abstract	Statin use has been associated with reduced cancer-specific mortality among patients with several cancer types, including multiple myeloma (MM). We aimed to further elucidate the association of statin use and dose intensity with MM survival. Using Swedish population-based national health registers, we identified all incident MM diagnoses occurring January 1, 2007 to December 31, 2013 and their drug dispensations and comorbidities. We assessed statin exposure in 6-month periods pre- and post-diagnosis, treated diagnosis as baseline for calculating survival time, and calculated hazard ratios (HR) and 95% confidence intervals (CI) of exposure-related MM-specific and all-cause mortality using Cox regression. We assessed statin exposure during the entire follow-up and risk of MM-specific mortality in a nested case-control analysis. We classified dose intensity according to American College of Cardiology/American Heart Association recommendations. We ascertained 4315 MM cases during follow-up. Statin use was associated with reduced MM-specific mortality (pre-diagnosis use multivariate-adjusted HR, 95% CI: 0.83, 0.71-0.96; 6 months post-diagnosis: 0.73, 0.60-0.89; entire follow-up: 0.65, 0.52-0.80) and (more weakly) with all-cause mortality. Intensity analyses suggested a dose-response; MM-specific mortality decreased with increasing statin intensity in all time windows (eg, 6 months post-diagnosis: low [0.76 (0.56-1.03)], medium [0.73 (0.58-0.92)], high [0.33 (0.08-1.32)] intensity). However, relatively few patients received high intensity treatment, and the trend was statistically significant only for unadjusted pre-diagnosis use. In this large population-based MM cohort, statin use was associated with improved MM-specific survival in both sexes. Randomized prospective studies are warranted to evaluate statins as adjuvant treatment in MM.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage ; Male ; Middle Aged ; Multiple Myeloma/drug therapy ; Multiple Myeloma/mortality ; Registries ; Retrospective Studies ; Survival Rate ; Sweden/epidemiology
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors
Language	English
Publishing date	2020-03-20
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	196767-8
ISSN	1096-8652 ; 0361-8609
ISSN (online)	1096-8652
ISSN	0361-8609
DOI	10.1002/ajh.25778
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Article ; Online: Survival of very elderly patients with diffuse large B-cell lymphoma according to treatment intensity in the immunochemotherapy era: a Swedish Lymphoma Register study.

Sonnevi, Kristina / Wästerlid, Tove / Melén, Christopher M / Harrysson, Sara / Smedby, Karin E / Wahlin, Björn E

British journal of haematology

2020 Volume 192, Issue 1, Page(s) 75–81

Abstract: Diffuse large B-cell lymphoma (DLBCL) incidence rises with increasing age. Rituximab-anthracycline-based regimens offer a potential cure but also risks of adverse events, especially in the elderly. Using Swedish registers, we conducted a nationwide, ... ...

Abstract	Diffuse large B-cell lymphoma (DLBCL) incidence rises with increasing age. Rituximab-anthracycline-based regimens offer a potential cure but also risks of adverse events, especially in the elderly. Using Swedish registers, we conducted a nationwide, population-based study of DLBCL in the very elderly. We obtained information on clinical characteristics, residence, comorbidity, therapy and survival for the 1194 patients aged ≥80 years diagnosed in Sweden 2007-2014. To address selection bias, we also investigated treatment differences between Sweden's Healthcare Regions and whether there were survival differences between the Regions. The 2-year overall and relative survivals were better in patients aged ≥80 years given treatment with curative intent (54%; 64%) than low-intensity (26%; 33%), or palliative treatment (6%; 7%). The fraction of patients treated with curative intent varied between the Healthcare Regions (45-76%). Survival was significantly inferior in Regions with few patients treated with curative intent (multivariable hazard ratio 1.3, 95% confidence interval 1.1-1.6). When treatment intensity and Regions competed, Regions were no longer independent, suggesting that Regional survival differences are due to therapeutic differences. Furthermore, we found that the age-adjusted International Prognostic Index was independently associated with survival. We conclude that patients aged ≥80 years with DLBCL appear to benefit from rituximab-anthracycline-based treatment given with curative intent.
MeSH term(s)	Age Factors ; Aged, 80 and over ; Antineoplastic Agents, Immunological/therapeutic use ; Female ; Follow-Up Studies ; Humans ; Immunotherapy ; Lymphoma, Large B-Cell, Diffuse/epidemiology ; Lymphoma, Large B-Cell, Diffuse/therapy ; Male ; Rituximab/therapeutic use ; Survival Analysis ; Sweden/epidemiology
Chemical Substances	Antineoplastic Agents, Immunological ; Rituximab (4F4X42SYQ6)
Language	English
Publishing date	2020-05-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80077-6
ISSN	1365-2141 ; 0007-1048
ISSN (online)	1365-2141
ISSN	0007-1048
DOI	10.1111/bjh.16737
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Article ; Online: Survival by First-line Treatment Type and Timing of Progression Among Follicular Lymphoma Patients: A National Population-based Study in Sweden.

Weibull, Caroline E / Wästerlid, Tove / Wahlin, Björn Engelbrekt / Andersson, Per-Ola / Ekberg, Sara / Lockmer, Sandra / Enblad, Gunilla / Crowther, Michael J / Kimby, Eva / Smedby, Karin E

HemaSphere

2023 Volume 7, Issue 3, Page(s) e838

Abstract: In follicular lymphoma (FL), progression of disease ≤24 months (POD24) has emerged as an important prognostic marker for overall survival (OS). We aimed to investigate survival more broadly by timing of progression and treatment in a national population- ... ...

Abstract	In follicular lymphoma (FL), progression of disease ≤24 months (POD24) has emerged as an important prognostic marker for overall survival (OS). We aimed to investigate survival more broadly by timing of progression and treatment in a national population-based setting. We identified 948 stage II-IV indolent FL patients in the Swedish Lymphoma Register diagnosed 2007-2014 who received first-line systemic therapy, followed through 2020. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by first POD at any time during follow-up using Cox regression. OS was predicted by POD using an illness-death model. During a median follow-up of 6.1 years (IQR: 3.5-8.4), 414 patients experienced POD (44%), of which 270 (65%) occurred ≤24 months. POD was represented by a transformation in 15% of cases. Compared to progression-free patients, POD increased all-cause mortality across treatments, but less so among patients treated with rituximab(R)-single (HR = 4.54, 95% CI: 2.76-7.47) than R-chemotherapy (HR = 8.17, 95% CI: 6.09-10.94). The effect of POD was similar following R-CHOP (HR = 8.97, 95% CI: 6.14-13.10) and BR (HR = 10.29, 95% CI: 5.60-18.91). The negative impact of POD on survival remained for progressions up to 5 years after R-chemotherapy, but was restricted to 2 years after R-single. After R-chemotherapy, the 5-year OS conditional on POD occurring at 12, 24, and 60 months was 34%, 46%, and 57% respectively, versus 78%, 82%, and 83% if progression-free. To conclude, POD before but also beyond 24 months is associated with worse survival, illustrating the need for individualized management for optimal care of FL patients.
Language	English
Publishing date	2023-02-23
Publishing country	United States
Document type	Journal Article
ISSN	2572-9241
ISSN (online)	2572-9241
DOI	10.1097/HS9.0000000000000838
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