Abstract
Between 1998 and 2009, a total of 295 patients (median age 58, 53% females) with newly diagnosed early-stage follicular lymphoma (FL) were managed at Memorial Sloan Kettering Cancer Center. Approximately half of patients (137, 46%) underwent initial observation and half (158, 54%) immediate treatment: radiation alone (n = 108), systemic treatment alone (n = 29), or combined modality treatment (n = 21). Median follow-up was 8.4 years (range 0.3–17.2), and 10-year overall survival (OS) was 87.2%. OS was similar between initially-observed and immediately-treated patients (hazard ratio [HR]: 1.25, 95% CI: 0.67–2.36, p = 0.49). For patients receiving radiation alone, 5-year OS was 98.0%. Patients selected for systemic therapy alone had high-risk baseline features and had shorter OS than patients treated with radiation alone (HR 3.38, 95% CI 1.29–8.86, p = 0.01). Combined modality treatment did not yield superior survival compared with radiation alone (P > 0.05) but was associated with better progression-free survival (HR 0.36, 95% CI 0.14–0.90, p = 0.03). The rate of transformation increased steadily over time and was 4.2% at 5 years and 10.8% at 10 years. This modern-era analysis rationalized the role of initial observation in patients with early-stage FL although patients receiving radiation therapy also demonstrate excellent outcome.
Highlights
Follicular lymphoma (FL) is the most common indolent lymphoma in the United States [1]
We identified 295 eligible patients diagnosed with grade 1–3 A, stage I–II FL managed at Memorial Sloan Kettering Cancer Center from 1998 to 2009 (Fig. 1)
Follicular Lymphoma International Prognostic Index (FLIPI) score at diagnosis was prognostic for Overall survival (OS), with patients in the low-risk category demonstrating better survival than patients in the intermediate/high-risk category (HR 0.22, 95% confidence intervals (CI) 0.10–0.47, log-rank P < 0.001)
Summary
Follicular lymphoma (FL) is the most common indolent lymphoma in the United States [1]. Initial management of FL depends on the stage at presentation. One-quarter of cases are early-stage (stage I–II) at diagnosis [1, 2]. Though patients with advanced-stage FL are considered incurable and are generally treated with chemoimmunotherapy when treatment is warranted, patients with stage I-II FL can be managed with a number of different approaches. Initial observation has been reported to be an acceptable treatment option for patients with early-stage FL. This conclusion was largely based on small retrospective experiences before the use of modern imaging modalities [3, 4]. The initial observation strategy has not been well validated in a larger patient population where 2-[18F]-Fluoro-2-deoxyglucose (FDG)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
