PurposeTo investigate outcome for patients with follicular lymphoma (FL) stage I-II treated at a population-based referral institution with a median follow-up of 15 years. Overall and cause-specific survival was compared to that of a sex, age and residency matched individuals from normal population.Material and Methods404 patients with early stage FL treated between 1980 and 2005 were retrospectively analyzed. Two of three patients had stage I disease. Based on clinical characteristics, first line treatments were radiotherapy (RT) (48% of patients), chemotherapy (CT) (16%), combined chemo-and radiotherapy (CRT) (16%) or observation (OBS) (15%). Survival was modeled with Kaplan-Meier methodology. Multivariate analyses were performed with the Cox model.ResultsFifteen years overall survival (OS), progression free survival (PFS) and time to next treatment (TNT) were 50% (95% confidence interval [CI]: 45–55), 42% (95% CI: 36–47) and 48% (95% CI, 42–54), respectively. For patients treated with RT 97% achieved a complete remission, and 15 year OS, PFS and TNT were 57% (95% CI, 50–64), 46% (95% CI, 39–54) and 49% (95% CI, 42–57), respectively. Relapse rate after RT and CRT was 49% and 36%, respectively. Only 2% of patients who received RT or CRT relapsed inside the radiation field and 5% had isolated near-field relapse. No statistical differences were found between treatment groups regarding death from cardiovascular disease or incidence of second cancer. Compared to a matched normal population, non-lymphoma cancer mortality was higher among patients given RT, hazard ratio 1.66 (95% CI: 1.14–2.42; P<0.01). Compared to other treatment modalities, patients selected for observation without treatment did not have inferior outcome.ConclusionsA differentiated treatment strategy in early stage FL results in long term survival for the majority of patients. OBS is a valid initial choice for selected patients without lymphoma-related symptoms.

Diffuse large B-cell lymphoma (DLBCL) patients have a median age of 70 years. Yet, empirical knowledge on treatment for older patients is limited as they are frequently excluded from clinical trials. We aimed to construct a simplified frailty score and examine survival and treatment-related mortality (TRM) according to frailty status and treatment intensity in an older, real-world DLBCL population. All patients ≥70 years diagnosed with DLBCL 2006-2016 in south-eastern Norway (n=784) were included retrospectively, and divided into a training (n=522) and validation cohort (n=262). We constructed and validated a frailty score based on geriatric assessment variables, and examined survival and TRM according to frailty status and treatment. The frailty score identified three frailty groups with distinct survival and TRM, independent of established prognostic factors (2-year overall survival (OS) fit 82%, unfit 47%, frail 14%, P&lt;0.001). For fit patients, full-dose R-CHOP (initial dosage&gt;80%) was associated with better survival than attenuated R-CHOP (2-year OS 86% vs 70%, P=0.012), also in adjusted analysis. For unfit and frail patients, full-dose R-CHOP was not superior to attenuated R-CHOP, while an anthracycline-free regimen was associated with poorer survival in adjusted analyses. A simplified frailty score identified unfit and frail patients with higher risk of death and TRM, which can aid treatment intensity decisions in older DLBCL patients. In this study, fit patients benefit from full-dose R-CHOP, while unfit and frail patients have no benefit of full-dose R-CHOP over R-miniCHOP. An online calculator for assessment of the frailty score is available at https://wide.shinyapps.io/app-frailty/.

In this single-center, population-based, and retrospective study, we analyzed the outcome of 49 patients with solitary bone plasmacytoma (SBP) and 28 patients with solitary extramedullary plasmacytoma (SEP), all treated with radiotherapy. Laminectomy was performed in 18/30 SBP patients with vertebral involvement and tumour resection in 10 SEP patients. Overall survival and cause of death for each patient were compared to 5 sex-, age-, and residency-matched individuals from the normal population. Response (complete and partial) was achieved in 94% of SBP and 96% of SEP patients. Relapse rates were higher in SBP (65%) compared to patients with SEP (18%) (P < .01). Only one in-field relapse was identified for the whole series. Ten- and 15-year overall survival, progression free survival (PFS) and multiple myeloma free survival (MMFS) for patients with SBP were 60%/41%, 25%/17%, and 33%/33%. Corresponding values for patients with SEP were 67%/54%, 57%/44%, and 91%/91%. SBP patients had significantly shorter PFS and MMFS compared to SEP patients (P < .01 for both). Only two of the SEP patients developed multiple myeloma and no patient in the whole series progressed to multiple myeloma later than 10 years after diagnosis. Unlike for SEP, the major cause of death among SBP patients was multiple myeloma (49%). Compared to matched normal population, no increased risk of death from secondary malignancies or cardiovascular disease was observed. Positive predictors in SBP patients were for overall survival age <60 years, combined laminectomy and radiotherapy and radiotherapy dose >40 gray, for PFS tumour size <6 cm and combined laminectomy and radiotherapy and for MMFS tumour size <6 cm. Radiotherapy confers excellent local control in both SEP and SBP patients; however, the challenge is to prevent development of multiple myeloma in patients with SBP.

In this study with prolonged follow up, we compared clinical outcome, including cause of death and incidence of second cancer, for patients with early stage extranodal marginal zone lymphoma (EMZL, 49 patients), nodal marginal zone lymphoma (NMZL, nine patients) and mantle cell lymphoma (MCL, 42 patients) with emphasis on potential benefit of radiotherapy. Radiotherapy was given to 40 patients with EMZL (nine had surgery only) and all NMZL patients. MCL patients received radiotherapy (17 patients), chemotherapy followed by radiotherapy (13 patients) or chemotherapy alone (12 patients). Compared to a matched control population no increased risk of second cancer or cardiovascular disease was observed. Radiotherapy alone was effective in EMZL and NMZL with low-relapse rates (20% and 33%) and a 10-year overall survival of 78% and 56%, respectively. High-relapse rate and inferior OS in MCL underline the need for extended staging with endoscopy and PET/CT and possibly for novel strategies.

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