June 29, 2013 - "Time, Time, Time Is on My Side, Yes It Is"

OK, this is really good news. A study of the survival rate of follicular lymphoma patients is showing a significant and steadily growing improvement since the 1960s.

The study results are published in an article, “Improvements in observed and relative survival in follicular grade 1-2 lymphoma over four decades: The Stanford University experience,” in Blood, June 18, 2013.

I don’t have follicular lymphoma — the small cells in my “B-cell, diffuse mixed large and small cell” grading evidently don’t display the same shape under a microscope as do follicular cells — but both are small-cell indolent lymphomas, treated more-or-less the same way. So, I take this good news to apply to my situation as well.

I’ve known this for years — that survival rates are getting better and better, as new treatments are steadily being rolled out — but it’s good to see some actual numbers, as part of a long-term historical study.

The study conducted at Stanford University identifies four historical eras:

Era 1, pre-anthracycline (1960-1975)
Era 2, anthracycline (1976-1986)
Era 3, aggressive chemotherapy/purine analogs (1987-1996)
Era 4, rituximab (1997-2003)

I’m off the chart in this study — a member of Era 5 — because I received my R-CHOP chemo (three chemo agents including anthracycline, plus the steroid prednisone, plus rituximab) in early 2006. So, my odds ought to be as good as, and probably better than, the era-4 patients.

Median overall survival rate steadily improved from approximately 11 years in eras 1 and 2 to 18.4 years in era 3. It’s not yet been reached for era 4 — because too many people in that cohort are still alive for researchers to have established their median age at death.

OK, so pre-rituximab follicular lymphoma patients are surviving for an average of 18.4 years after treatment. Rituximab-era patients up through 2003 are presumably doing much better than that (although the researchers can’t say, yet, by how much, because the numbers still aren’t in). I’m in the 15-year cohort beyond even that, that still hasn’t closed.

Even if the Era 4 numbers were to surprise everyone and reflect only a very modest gain (say, a 20-year average overall survival rate), that would peg the typical life expectancy of people who were treated at age 49, as I was, at age 69. Yet, because of the revolutionary impact of rituximab, the Era 4 group’s survival rate will likely prove to be much higher than that.

The news gets better. I’m not in Era 4. I’m in the yet-to-be-studied Era 5. Projecting the Stanford researchers’ steady increase into the future, that would push the average overall survival rate for patients from my era higher still.

I’m aware that I’m basing this speculation on the abstract, rather than the full article (which requires a subscription to the journal, Blood, to read online). I’m also aware that, once we get out of Era 3 (the latest one for which an actual median overall survival rate can be measured), we’re dealing in some very soft — and in the case of my Era 5 — even non-existent numbers. But, the trends look good.

“So teach us to count our days that we may gain a wise heart” (Psalm 90:12). I’m pretty sure the psalmist is talking about remaining aware of just how soon one’s own death may be coming. Does numbering our days in the opposite direction make us less wise?

I don’t know, and I don't much care. I’ll take the good news, all the same.