Are Survival Statistics for Follicular Lymphoma Changing?

As I have warned before, survival statistics for cancer, especially for indolent cancers like follicular lymphoma, can be highly misleading. Median figures say little about where most people actually fall on a curve. And it is still a curve -- there's no way to say where on that curve your particular data point sits. Plus, that curve applies only to historical patients, not (necessarily) to current ones. The 5-year survival curve published today applies only to patients diagnosed 5 years ago.

One historical problem is clear in follicular lymphoma, though: it's easy to induce a partial remission with chemotherapy, and fiendishly difficult to actually extend lifespan with effective treatment. This is one of the basic realizations that informs the "watch & wait" strategy of today: hold off on the hard drugs, because early treatment doesn't really help much. Alkalating agent-based protocols, like CHOP, had only modest effects on overall survival.

Then rituximab came along. Actually, that particular anti-CD20 monoclonal antibody was simply the first in a series of revolutionary new lymphoma drugs, but it has resulted in massive change in the statistical picture. The question now is how much overall survival has changed in the past decade, and whether that means altering our understanding of how follicular lymphoma should be treated. Which is why studies like the recent immediate-maintenance-rituximab trial get press despite their obvious flaws. So how far have we come, anyways?