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Effectiveness of first-line management strategies for stage I follicular lymphoma: analysis of the National LymphoCare Study.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2012 Sep 20; Vol. 30 (27), pp. 3368-75. Date of Electronic Publication: 2012 Aug 20. - Publication Year :
- 2012
-
Abstract
- Purpose: The optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT).<br />Patients and Methods: We analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database.<br />Results: Of 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28%), XRT (27%), observation (17%), systemic therapy + XRT (13%), rituximab monotherapy (12%), and other (3%). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21% of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival.<br />Conclusion: In this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.
- Subjects :
- Antibodies, Monoclonal, Murine-Derived therapeutic use
Antineoplastic Agents therapeutic use
Combined Modality Therapy
Follow-Up Studies
Guideline Adherence
Humans
Lymphoma, Follicular pathology
Lymphoma, Follicular radiotherapy
Middle Aged
Neoplasm Staging
Practice Guidelines as Topic
Registries statistics & numerical data
Rituximab
Survival Analysis
Treatment Outcome
United States
Lymphoma, Follicular therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 30
- Issue :
- 27
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 22915662
- Full Text :
- https://doi.org/10.1200/JCO.2011.40.6546