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

Journal of Hematology & Oncology

Bertrand B Coiffier³  Gilles G Salles³  Anne A D’Hombres⁷  Christelle C Tychyj-Pinel⁶  Françoise F Berger⁴  Fadhela F Bouafia-Sauvy⁵  Deborah D Bauwens¹  Laure L Lebras³  Anne-Sophie AS Michallet² 

[1] Clinique Universitaire Saint Luc, UCL, Woluwe Saint Laurent, Belgium;Service d’Hématologie Clinique, Centre Hospitalier Lyon Sud, 165 chemin du Grand Revoyet, F-69310 Pierre Bénite, France;Université de Lyon, Faculté de Médecine Lyon-Sud Charles Mérieux, Pierre Bénite, France;Department of Anatomopathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France;Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France;Department of Radiology and Nuclear Medicine, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France;Department of Radiotherapy, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France

关键词: Radiotherapy;    Rituximab;    Complete response;    Chemotherapy;    Follicular lymphoma;   

Others  :  804678
DOI  :  10.1186/1756-8722-6-45

 received in 2013-04-14, accepted in 2013-06-26,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Michallet et al.; licensee BioMed Central Ltd.

【 图 表 】

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