Life expectancy of young adults with follicular lymphoma

Background: This study was aimed at investigating the clinical features and outcomes of follicular lymphoma ( FL) patients younger than 40 years, which have not been extensively investigated yet. Patients and methods: One hundred and fifty- five patients younger than 40 years were retrospectively studied from a series of 1002 FL patients diagnosed in four different European Oncology Centres ( Barcelona, Spain; Bellinzona, Switzerland; London, UK; Novara, Italy) from 1985 to 2010. Results: Patients younger than 40 had a lower incidence of elevated LDH, high beta2- microglobulin, and a high- risk Follicular Lymphoma International Prognostic Index ( FLIPI) score, whereas bone marrow involvement and bulky and disseminated lymphadenopathy were more frequent. At a median follow- up of 10 years, younger patients, in comparison with those older than 40, had significantly better overall ( OS), cause- specific survival ( CSS), and progression- free survival ( PFS), with 10- year OS rate of 81% versus 51% ( P < 0.0001), 10- year CSS rate of 82% versus 60% ( P < 0.0001), and 10- year PFS of 39% versus 24% ( P = 0.0098). However, there were no significant CSS and PFS differences in comparison with the patients aged 40- 60. In multivariate analysis, having the lymphoma diagnosed in the last two decades and a favourable FLIPI score were associated with a significantly longer PFS and CSS in younger patients, whereas only FLIPI retained statistical significance for OS. Conclusions: In our series, FL patients younger than 40 have a median OS of 24 years and their outcome seems to be improving over time. However, they still have a significantly shorter life expectancy than that of an age- matched general healthy population.