The leading cause of death for patients with follicular lymphoma was the disease itself, despite gains in survival due to rituximab treatment, authors of a retrospective pooled analysis, published in the Journal of Clinical Oncology, reported.1

Study researchers pooled data from 2 cohorts of patients with newly diagnosed follicular lymphoma grade 1 through grade 3A. One cohort was from US-based institutions and included 920 patients; the other was from French-based institutions and included 734 patients.

The US and French cohorts has similar 10-year overall survival rates (77% vs 80%, respectively). Between both cohorts, a combined 283 deaths occurred by 10 years, for which, 248 (88%) had a classified cause of death.

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Overall, by 10 years, 10.3% of patients died from follicular lymphoma, making it the most common cause of death. The next most common cause was treatment-related mortality, causing 3.0% of deaths. Other causes of death included other malignancy (2.9%), other causes (2.2%), and unknown cause (3.0%).

Patients who reached 24-month event-free survival (EFS) had a similar subsequent cumulative incidence of lymphoma- and non–lymphoma-related mortality; the 10-year cumulative incidence was 6.7% for lymphoma-related mortality and 5.7% for non–lymphoma-related mortality. Those who did not reach 24-month EFS, however, had higher subsequent cumulative incidence of lymphoma-related mortality than non–lymphoma-related mortality; the 10-year cumulative incidence was 36.1% for lymphoma-related mortality and 7.0% for non–lymphoma-related mortality.

More than half of deaths caused by lymphoma (77 of 140) were in patients who had follicular lymphoma that had transformed after diagnosis.

“Despite the improvement in overall survival in patients with FL [follicular lymphoma] in the rituximab era, their leading COD [cause of death] remains lymphoma, especially after disease transformation. Treatment-related mortality also represents a concern, which supports the need for less-toxic therapies,” the study authors wrote in conclusion.


  1. Sarkozy C, Maurer MJ, Link BK, et al. Cause of death in follicular lymphoma in the first decade of the rituximab era: a pooled analysis of French and US cohorts. J Clin Oncol. 2019;37(2):144-152.