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Blood Adv. 2019 Oct 8;3(19):2804-2811. doi: 10.1182/bloodadvances.2019000458.

Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance.

Author information

1
Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
2
Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
3
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
4
Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia.
5
Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia.
6
Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia.
7
Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada.
8
Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia.
9
Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia.
10
Department of Haematology, Townsville Hospital, Townsville, QLD, Australia.
11
Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia.
12
Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia.
13
Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia.
14
Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia.
15
Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada.
16
Department of Haematology, Canberra Hospital, Canberra, ACT, Australia.
17
Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; and.
18
QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia.

Abstract

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.

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