Advance and stagnation in the treatment of patients with lymphoma and myeloma: Analysis using population‐based cancer registry data in Japan from 1993 to 2006

Abstract

There have been significant advances in the treatment of patients with lymphoma and myeloma. Although the improvements in survival outcome have been clearly addressed by clinical trials, these studies includes patients who are otherwise healthy and would be eligible for trials that the actual improvement in survival in the general patient population over time is yet to be elucidated. Therefore, we reviewed the cancer-registry data of patients with lymphoma and myeloma in Japan from 1993 to 2006 and estimated relative survival (adjusted for competing causes of death in same-age members of the general population) according to three periods of diagnosis (1993-1997, 1998-2002 and 2003-2006). We also estimated conditional 5-year relative survival (5-year survival rate of patients who have survived 5 years). A total of 26,141 patients were reviewed and analyzed. Relative survival improved in Hodgkin lymphoma (HL, N 5 853, 120% improvement), diffuse large B-cell lymphoma (DLBCL, N 5 4,919, 114% improvement) and follicular lymphoma (FL, N 5 1,333, 113% improvement). In contrast, we found no significant improvement in survival since 1993 in peripheral T-cell lymphoma (PTCL, N 5 667, 14% improvement), adult Tcell leukemia/lymphoma (ATLL, N 5 2,166, 25% improvement) or multiple myeloma (MM, N 5 4,914, 22% improvement). Conditional 5-year survival of HL, DLBCL, FL, PTCL, ATLL and MM was 88, 87, 79, 63, 53 and 45%, respectively. Relative survival of patients with HL, DLBCL and FL significantly improved from 1993 to 2006 in Japan; in contrast, no improvement was seen in other diseases, suggesting unmet need of novel treatment strategies.

Contributions of Subtypes of Non-Hodgkin Lymphoma to Mortality Trends

“…CHOP is the standard therapy for PTCL ( 51) although new drugs (pralatrexate and romidepsin) received approval in 2009 ( 52, 53). Survival is generally described as poor, although our cancer-specific survival estimate of approximately 65% for PTCL was higher than previously suggested ( 54, 55). We find that 5-year cancer-specific survival for the PTCL cases not otherwise specified was 40%, similar to what is reported in the literature (54, 55).…”

“…Survival is generally described as poor, although our cancer-specific survival estimate of approximately 65% for PTCL was higher than previously suggested ( 54, 55). We find that 5-year cancer-specific survival for the PTCL cases not otherwise specified was 40%, similar to what is reported in the literature (54, 55). Our PTCL classification does include Alk+ T-cell lymphoma, and this also has a low survival rate (5-year survival 52%).…”

Nationwide claims database analysis of treatment patterns, costs and survival of Japanese patients with diffuse large B-cell lymphoma

“…Stratified Kaplan-Meier survival analyses showed worse survival with increasing age, male gender, and use of chemotherapy without R. Such trends were also observed in an US SEER registry study [23]. Association of R-based regimens with higher survival rates has been suggested in earlier reports [4,8,9]. Our results further demonstrate that the survival rate was highest with R-CHOP, followed by R-CVP, R + other chemotherapy and chemotherapy without R, which were also supported by TTNT outcomes, reflecting the treatment modality of patients in another real-world setting study [24].…”

Rapidly changing myeloma epidemiology in the general population: Increased incidence, older patients, and longer survival

“…Five‐year relative survival in the last period 2003‐2006 was only 27.8% which is considerably lower than that reported from the USA and Europe; however, survival rates were reported to be combined for all age groups, and there was no age‐stratified information on relative survival for younger and older patients. In Japan, thalidomide, bortezomib, and lenalidomide were not approved during the period under study …”

“…Five‐year overall survival increased from 31.2 to 50.3 months in a study from 18 affiliated hospitals in Japan comparing two calendar periods 1990‐2000 and 2001‐2012 which should be compared with a 5‐year relative survival of 27.8% in a registry‐based study from Japan 2003‐2006 …”