The results chapter is divided into six subchapters; Hodgkin lymphoma, non-Hodgkin lymphoma, mature lymphoid leukaemia, myeloma, lymphoblastic- and Burkitt lymphoma/leukaemia and other.
The incidence of Hodgkin lymphoma has been stable over the last 15 years and the prognosis is good. However, older patients have significantly poorer survival than younger patients do. The use of PET scans have most likely led to fewer stage I patients and more stage IV patients. Patients with stage III-IV at diagnosis often have B-symptoms (night sweats, fever, weight loss), but most patients diagnosed with Hodgkin lymphoma are generally in good health. The results indicate that Helse Midt-Norge use radiation therapy as part of the first-line treatment of Hodgkin lymphoma more frequently than the rest of the country.
This report focuses on the process of correct diagnostics of lymphoid malignancies. Histological type of non-Hodgkin lymphoma is of great importance for the patients’ prognosis and the choice of treatment. The results show that some hospitals still deviate from the guidelines of consulting university hospitals when diagnosing lymphoma. This especially applies to Akershus universitetssykehus and Helse Møre og Romsdal, Ålesund. There may be several reasons for this practice. Other quality indicators, such as staging and use of biopsy, are satisfactory.
For most subgroups of non-Hodgkin lymphoma, the incidence has been stable over the last 15 years. Improved diagnostics, better chemotherapy regimens and the use of antibody (especially the anti-CD20 antibody rituximab) have led to increased survival in all subgroups. There are, however, variations in survival for patients over the age of 70 that may not be explained by natural variations alone. This issue will be studied in a PhD project in cooperation with the lymphoma registry.
The patients´ performance status and occurrence of B-symptoms are largely dependent on the subgroup of lymphoma. Patients diagnosed with aggressive lymphomas have a poorer general health condition than patients diagnosed with indolent lymphomas. Results indicate that hospitals follow the national guidelines for treating large B-cell lymphoma. The current level of reporting is, however, too low for us to conclude on this with certainty. Radiotherapy as part of first-line treatment for large B-cell lymphoma varies between the four regional health authorities, but also between hospitals within the same region.
Mature lymphoid leukaemia, which mainly consist of chronic lymphocytic leukaemia, have a stable incidence and an increasing 5-year relative survival. Increased survival is attributed to the increased use of chemo-immunotherapy, as for NHL. Immunophenotyping by flow cytometry is the recommended diagnostic method for suspected chronic lymphocytic leukaemia (CLL). This method is also used to set a CLL score that gives an indication of whether the CLL diagnosis is correct. Staging according to Binet is used to assess whether the patient needs treatment. The report shows correct diagnosis of CLL patients in all health regions. Mutational status and preferred IGHV gene is of significance, but the vast majority of patients diagnosed with mature lymphoid leukaemia have a good general health condition at the time of diagnosis and do not need treatment.
This year we have also chosen to include data from the Norwegian Patient Registry (NPR) in order to examine potential differences in the choice of treatment for chronic lymphocytic leukemia at diagnosis. The analysis shows variations between the different health trusts.
The incidence of myeloma has gradually increased since 2002. 5-year relative survival has increased from 37 % to 62,5 % in the same period. Prognoses are significantly better for younger patients, than for patients over the age of 71. There are, however, variations in survival between the different hospitals. The revised national guidelines for haematological malignancies recommends doing a bone marrow biopsy in addition to bone marrow aspiration when diagnosing myeloma. As of the 2018 report, a target level for bone marrow biopsies was set at 90 %. In 2020, this target was reached for the first time. The use of FISH-analysis and reporting of ISS-stadium is incomplete.
The incidence of lymphoblastic lymphoma/leukaemia and Burkitt lymphoma/ leukaemia has been stable since 2002. Survival has increased significantly, coinciding with the change in 2009-2010 of treatment guidelines for acute lymphoblastic leukaemia for patients under the age of 45.