Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance.
Joshua W D TobinGabrielle RuleKatherine ColvinLourdes CalventeDavid HodgsonStephen BellChengetai DunduruJames GalloErica S TsangXuan TanJonathan Wing Kit WongJessica PearceRobert CampbellShao TnehSophie ShortenMelissa NgTara CochraneConstantine S TamEmad AbroEliza A HawkesGeorgina HodgesRoopesh KansaraDipti TalaulikarMichael GilbertsonAnna M JohnstonKerry J SavageDiego R VillaKirk MorrisSumi RatnasingamWojt JanowskiRobert KridelChan Y CheahMichael P MacManusNicholas A MatigianPeter MolleeMaher K GandhiGreg HapgoodPublished in: Blood advances (2020)
Management practices in early-stage (I/II) follicular lymphoma (FL) are variable and include radiation (RT), systemic therapy, or combined modality therapy (CMT). There is a paucity of data regarding maintenance rituximab in this cohort. We conducted an international retrospective study of patients with newly diagnosed early-stage FL staged with positron emission tomography (PET)-computed tomography and bone marrow biopsy. Three hundred sixty-five patients (stage I, n = 221), median age 63 years, treated from 2005-2017 were included, with a median follow-up of 45 months. Management included watchful waiting (WW; n = 85) and active treatment (n = 280). The latter consisted of RT alone (n = 171) or systemic therapy (immunochemotherapy [n = 63] or CMT [n = 46]). Forty-nine systemically treated patients received maintenance rituximab; 72.7% of stage I patients received RT alone, compared to 42.6% with stage II (P < .001). Active therapies yielded comparable overall response rates (P = .87). RT alone and systemic therapy without maintenance rituximab yielded similar progression-free survival (PFS) (hazard ratio [HR], 1.32; 95% confidence interval [CI], 0.77-2.34; P = .96). Maintenance rituximab improved PFS (HR, 0.24; 95% CI, 0.095-0.64; P = .017). The incidence of transformation was lower with systemic therapy compared to RT or WW (HR, 0.20; 95% CI, 0.070-0.61; P = .034). Overall survival was similar among all practices, including WW (P = .40). In the largest comparative assessment of management practices in the modern era, variable practices each resulted in similar excellent outcomes. Randomized studies are required to determine the optimal treatment in early-stage FL.
Keyphrases
- newly diagnosed
- early stage
- computed tomography
- positron emission tomography
- end stage renal disease
- diffuse large b cell lymphoma
- primary care
- chronic kidney disease
- ejection fraction
- bone marrow
- healthcare
- free survival
- peritoneal dialysis
- squamous cell carcinoma
- type diabetes
- prognostic factors
- magnetic resonance imaging
- magnetic resonance
- clinical trial
- skeletal muscle
- pet ct
- risk factors
- sentinel lymph node
- hodgkin lymphoma
- machine learning
- randomized controlled trial
- open label
- adipose tissue
- contrast enhanced
- combination therapy
- double blind
- lymph node
- radiation induced
- study protocol
- image quality