Journal Article

Early stage follicular lymphoma: what is the clinical impact of the first-line treatment strategy?

Michallet, Anne-Sophie AS, D’Hombres, Anne A, Salles, Gilles G, Berger, Françoise F, Coiffier, Bertrand B, Bouafia-Sauvy, Fadhela F, Tychyj-Pinel, Christelle C, Lebras, Laure L, Bauwens, Deborah D

2013

Overview

Background Less than 20% of patients with follicular lymphoma (FL) present with Ann Arbor Stage I or II disease at diagnosis. Numerous therapeutic options exist, however radiation therapy is considered the standard of care for early-stage disease based on single-institution or retrospective series. Our aim was to revisit the outcome of patients with localized FL in the rituximab era. Patients and Methods We analyzed the characteristics and outcomes of 145 early-stage FL patients, who were retrospectively divided into six groups according to their initial treatment: watchful waiting (WW), chemotherapy alone (CT), radiotherapy alone (RT), combined radiotherapy and chemotherapy (RT-CT), rituximab alone (Ri), and immunochemotherapy (Ri-CT). Results Of the 145 patients, 84 (57.9%) had stage I disease and 61 (42.1%) stage II. The complete response (CR) rate varied from 57% for the Ri group to 95% for the RT-CT group. Overall survival (OS) at 7.5 y of patients treated after 2000 was better than that of those treated prior to 2000. OS did not significantly differ from one treatment to another. In contrast, a significant difference was found for progression-free survival (PFS) at 7.5 y, which favored Ri-CT (60%) therapy versus the others ( p= 0.00135). Conclusion Delayed therapy initiation was associated with a similar OS than that observed in patients receiving immediate intervention. The “watchful waiting” strategy may thus be proposed as first-line therapy, similar to stage III and IV FL patients with a low tumor burden. However, when treatment is required, immunochemotherapy appears to be the best option.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Age / Aged / Antimitotic agents / Antineoplastic agents / Cancer Research / Care and treatment / Chemoradiotherapy / Chemotherapy / Disease Progression / Disease-Free Survival / Female / Hematology / Humans / Immunotherapy / Lymphoma / Lymphoma, Follicular - drug therapy / Lymphoma, Follicular - pathology / Lymphoma, Follicular - radiotherapy / Lymphoma, Follicular - therapy / Lymphomas / Male / Medical treatment / Medicine / Medicine & Public Health / Middle Aged / Oncology / Patient outcomes / Radiation therapy / Radiotherapy / Retrospective Studies / Survival Analysis / Treatment Outcome