Cargando…

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

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....

Descripción completa

Detalles Bibliográficos
Autores principales: Michallet, Anne-Sophie AS, Lebras, Laure L, Bauwens, Deborah D, Bouafia-Sauvy, Fadhela F, Berger, Françoise F, Tychyj-Pinel, Christelle C, D’Hombres, Anne A, Salles, Gilles G, Coiffier, Bertrand B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723590/
https://www.ncbi.nlm.nih.gov/pubmed/23816219
http://dx.doi.org/10.1186/1756-8722-6-45
Descripción
Sumario: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.