Female patients with follicular lymphoma have a better prognosis if primary remission lasts over 24 months

Figures & data

Table 1. Patient characteristics according to sex.

Variable	Male (n = 494 ) n (%)	Female (n = 526) n (%)	p-value*
Age, years, median (range)	59 (18–100)	60 (17–92)	0.003
Age
under 60	257 (52.3)	232 (44.4)	0.012
60 or over	234 (47.7)	290 (55.6)
Missing	3	4
Grade
1 or 2	376 (83.6)	388 (81.7)	0.453
3	74 (16.4)	87 (18.3)
Missing	44	51
FLIPI
0–1	168 (38.6)	164 (35.0)	0.393
2	124 (28.5)	132 (28.1)
3–5	143 (32.9)	173 (36.9)
Missing	59	57
LDH level
Normal	268 (71.1)	281 (70.8)	0.925
Elevated	109 (28.9)	116 (29.2)
Missing	117	129
Hb (g/dL)
< 12	51 (11.2)	91 (19.1)	0.001
> 12	406 (88.8)	385 (80.9)
Missing	37	50
B-symptoms
Yes	73 (15.3)	92 (18.0)	0.255
No	405 (84.7)	420 (82.0)
Missing	16	14

a: FLIPI = Follicular Lymphoma International Prognostic Index.

b: LDH = lactate dehydrogenase.

c: B-symptoms = systemic symptoms (unexplained weight loss, fever, night sweats).

*Pearson’s chi-squared test.

Table 2. First-line treatments according to sex.

All patients	Male (n = 494) n (%)	Female (n = 526) n (%)	p-value*
Anthracycline-containing	284 (57.5)	282 (53.6)	0.213
Bendamustine	34 (6.9)	32 (6.1)	0.604
Fludarabine-containing	11 (2.2)	16 (3.0)	0.418
Less-intensive therapies (COP, CP, C, chlorambucil)	57 (11.5)	72 (13.7)	0.302
Surgical removal only	8 (1.6)	6 (1.1)	0.511
Rituximab-monotherapy	16 (3.2)	16 (3.0)	0.857
Combination therapy with rituximab	344 (69.6)	359 (68.3)	0.633
Rituximab maintenance	143 (28.9)	129 (24.5)	0.110
Radiotherapy only	50 (10.1)	58 (11.0)	0.639
Others	9 (1.8)	10 (1.9)	0.925
No treatment	25 (5.1)	34 (6.5)	0.337
Spain	Male (n = 158) n (%)	Female (n = 176) n (%)	p-value*
Anthracycline-containing	93 (58.9)	86 (48.9)	0.067
Less-intensive therapies	22 (13.9)	39 (22.2)	0.052
Rituximab maintenance	58 (36.7)	43 (24.4)	0.015
Finland	Male (n = 336) n (%)	Female (n = 350) n (%)	p-value*
Anthracycline-containing	191 (56.8)	196 (56.0)	0.823
Less-intensive therapies	35 (10.4)	33 (9.4)	0.665
Rituximab maintenance	85 (25.3)	86 (24.6)	0.826

a: COP = cyclophosphamide, vincristine, prednisolone.

b: CP = cyclophosphamide, prednisolone.

c: C = cyclophosphamide.

*Pearson’s chi-squared test.

The regimens for Spanish and Finnish subgroups presented in the table were selected as there were a trend toward difference in these regimens in Spanish patients.

Figure 1. Sex differences in survival. The log-rank test was used to calculate the statistical difference between subgroups. (A) Progression-free survival after first-line treatment (PFS1); (B) Disease-specific survival (DSS); (C) Overall survival (OS); (D) Progression-free survival after second-line treatment (PFS2).

Figure 2. Sex differences in disease-specific survival (DSS), overall survival (OS), and progression-free survival after second-line therapy (PFS2) according to the time of progression of disease (POD). The log-rank test was used to calculate the statistical difference between subgroups. PFS1 = Progression-free survival after first-line treatment. (A) DSS for patients with POD24; (B) OS for patients with POD24; (C) PFS2 for patients with POD24; (D) DSS for patients with PFS1 lasting over 24 months; (E) OS for patients with first PFS1 lasting over 24 months; (F) PFS2 for patients with PFS1 lasting over 24 months.

Figure 3. Sex differences in progression free survival after first-line treatment (PFS) and in disease-specific survival (DSS) according to the country of residence. The log-rank test was used to calculate the statistical difference between males and females. (A) PFS; (B) DSS.

Table 3. HR and adjusted HR for Sex Difference in PFS, DSS and OS.

	PFS		DSS		OS
Sex	0.720	0.615	0.653	0.366	0.653	0.377
HR [95% CI] (Female vs. male)	[0.588–0.881]	[0.465–0.813]	[0.488–0.951]	[0.219–0.609]	[0.501–0.853]	[0.263–0.539]
p-value	0.001	0.001	0.026	<0.001	0.002	<0.001
Covariates	No	Yes	No	Yes	No	Yes

HR: hazard ratio; CI: confidence interval; PFS: progression-free survival; DSS: disease-specific survival; OS: overall survival.

Covariates include sex, age, histology grade, hemoglobin, lactate dehydrogenase, B-symptoms, and FLIPI-score (Follicular Lymphoma-specific International Prognostic Index).

Estimations are made using Cox regression analysis.