FOLLICULAR LYMPHOMA EPIDEMIOLOGY AND OUTCOMES IN ENGLAND 2014–2021: PRELIMINARY ANALYSIS FROM THE UNCOVER STUDY GROUP

Abstract

Introduction: UNCOVER is a blood cancer health data research programme that utilises the National Cancer Registration Dataset (NCRD). NCRD includes information on all patients diagnosed with all types of cancer in all NHS institutions in England (Int J Epidemiol 2020; 49(1):16–16h).

Methods: NCRD data was obtained for all patients in England diagnosed with any type of blood cancer between Jan 2014 and Dec 2021. Patients with newly diagnosed follicular lymphoma (FL) were identified using ICD-O-3 codes 96953, 96913, 96983, and 96903. Crude and adjusted incidence rate ratios (IRR) were estimated and compared between groups using multivariable Poisson regression, and calendar time trends were assessed. Overall survival (OS), cause-specific and relative survival was assessed using K-M methods and multivariable Cox regression, Fine-Gray and Pohar-Perme models, respectively. All models were adjusted for age, gender, index of multiple deprivation (IMD) quintile and government region, while Cox and Fine-Gray models were also adjusted for ethnicity and Charlson co-morbidity index (CCI).

Results: 17561 patients with FL aged 18–99 were identified (demographics in Table 1). Gender (p < 0.001), age (p < 0.001), ethnicity (p < 0.001), region (p < 0.001) and year of diagnosis (p < 0.001) were independently associated with incidence. The adjusted IRR increased with age and was lower in females (0.90), in mixed-race (0.20), Asian (0.43) and black (0.28) people compared to white people, and in all 8 provincial regions compared to London (IRR for North West 0.81). The adjusted IRR for successive calendar years was generally stable but dipped in the first year of the COVID-19 pandemic [2020 vs. 2014; 0.94 (95% CI: 0.89–1.01)]. Survival data were available until July 2023 [median follow-up 4.4 years (IQR: 2.4–6.6)]. 4709 (26.8%) patients died, with 5-year OS 74% (95% CI: 74%–75%) and relative survival 85% (84%–86%). Gender (p < 0.001), age (p < 0.001), ethnicity (p = 0.044), CCI (p < 0.001), IMD (p < 0.001) and year of diagnosis (p = 0.008) were independently associated with OS. The adjusted hazard ratio (HR) increased with age [15.4 (95% CI: 11.6–20.6) for 75–99 vs. 18–44], deprivation [1.47 (1.33–1.61) for IMD1 vs. IMD5] and comorbidity [2.35 (2.09–2.64) for CCI ≥ 4 vs. 0] but was lower in females [0.78 (0.73–0.82)], in black versus white people [0.60 (0.38–0.93)], and in patients diagnosed in 2015 versus 2014 [0.86 (0.78–0.96)].

Conclusion: Our findings shed new light on FL epidemiology and outcomes in England during the period 2014–2021. Even when other variables such as age and comorbidity were taken into account, reported incidence was lower and survival shorter in people living in more deprived areas, identifying a group with significant unmet needs. A significant proportion of patients died of unrelated causes, underlining the importance of balancing efficacy with toxicity and quality of life when selecting treatment, especially for older patients and those with comorbidity.

Research funding declaration: This study was funded by Blood Cancer UK, North West Cancer Research, The Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool Institute of Population Health and Isle of Man Anti-Cancer Association.

Keywords: other; cancer health disparities; indolent non-Hodgkin lymphoma

Potential sources of conflict of interest:

K. M. Linton

Consultant or advisory role: Roche, Abbvie, Genmab, Nurix Therapeutics, BMS

Honoraria: Abbvie, Beigene, Nurix Therapeutics

Educational grants: Abbvie, Genmab

Other remuneration: Research funding—Roche, Genmab, Beigene, Nurix Therapeutics, Byondis, StepPharma, AstraZeneca

M. Bishton

Consultant or advisory role: Incyte, Roche, Lilly, AbbVie

Honoraria: Roche, Takeda, Celltrion, Kite/Gilead, Lilly, Abbvie, Recordati

Other remuneration: Research funding: Roche, Takeda, Genmab

A. Pettitt

Other remuneration: Research funding: AstraZeneca, Celgene/BMS, Roche