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Title: | Outcomes of stage I/II follicular lymphoma in the PET era: An international study from the Australian Lymphoma Alliance. | Authors: | Janowski W.;Johnston A.M.;Savage K.J.;Villa D.;Morris K.;Ratnasingam S.;Kridel R.;Cheah C.Y.;MacManus M.;Matigian N.;Mollee P.;Gandhi M.K.;Hapgood G.;Tobin J.W.D.;Rule G.;Colvin K.;Calvente L.;Hodgson D.;Bell S. ;Dunduru C.;Gallo J.;Tsang E.S.;Tan X.;Wong J.;Pearce J. ;Campbell R.;Tneh S.;Shorten S.;Ng M.;Cochrane T.;Tam C.S.;Abro E.;Hawkes E.;Hodges G.;Kansara R.;Talaulikar D.;Gilbertson M. | Institution: | (Tobin, Mollee, Gandhi, Hapgood) Department of Haematology, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD 4102, Australia (Rule, Colvin, Cheah) Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia (Calvente, Hodgson, Kridel) Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada (Bell, Janowski) Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia (Dunduru, Ratnasingam) Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia (Gallo, Morris) Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia (Tsang, Savage, Villa) Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada (Tan, Johnston) Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia (Wong, Gilbertson) Department of Clinical Haematology, Monash Health, Melbourne, VIC, Australia (Pearce, Hodges) Department of Haematology, Townsville Hospital, Townsville, QLD, Australia (Campbell, Hawkes) Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia (Tneh, Abro) Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia (Shorten, Tam) Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia (Ng, Cochrane) Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia (Kansara) Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada (Talaulikar) Department of Haematology, Canberra Hospital, Canberra, ACT, Australia (MacManus) Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (Matigian) QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia | Issue Date: | 26-Oct-2019 | Copyright year: | 2019 | Publisher: | American Society of Hematology (E-mail: publishing@hematology.org) | Place of publication: | United States | Publication information: | Blood Advances. 3 (19) (pp 2804-2811), 2019. Date of Publication: 08 Oct 2019. | 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 5 221), median age 63 years, treated from 2005-2017 were included, with a median follow-up of 45 months. Management included watchful waiting (WW; n 5 85) and active treatment (n 5 280). The latter consisted of RT alone (n 5 171) or systemic therapy (immunochemotherapy [n 5 63] or CMT [n 5 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 5 .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 5 .96). Maintenance rituximab improved PFS (HR, 0.24; 95% CI, 0.095-0.64; P 5 .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 5 .034). Overall survival was similar among all practices, including WW (P 5 .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.Copyright © 2019 by The American Society of Hematology | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1182/bloodadvances.2019000458 | PubMed URL: | 31570492 [http://www.ncbi.nlm.nih.gov/pubmed/?term=31570492] | ISSN: | 2473-9529 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/35979 | Type: | Article | Subjects: | prednisolone/cb [Drug Combination] adult aged article bone marrow biopsy cancer combination chemotherapy cancer immunotherapy cancer mortality cancer radiotherapy cancer recurrence *cancer staging cohort analysis comparative effectiveness controlled study distant metastasis/co [Complication] female *follicular lymphoma/dt [Drug Therapy] *follicular lymphoma/rt [Radiotherapy] follow up human human tissue lymph node metastasis/co [Complication] maintenance therapy major clinical study male monotherapy multimodality cancer therapy overall survival *positron emission tomography-computed tomography priority journal progression free survival radiation dose retrospective study survival rate survival time systemic therapy treatment failure treatment outcome watchful waiting bendamustine/cb [Drug Combination] bendamustine/dt [Drug Therapy] cyclophosphamide/cb [Drug Combination] cyclophosphamide/dt [Drug Therapy] doxorubicin/cb [Drug Combination] doxorubicin/dt [Drug Therapy] hemoglobin/ec [Endogenous Compound] prednisolone/dt [Drug Therapy] rituximab/cb [Drug Combination] rituximab/dt [Drug Therapy] rituximab/tm [Unexpected Outcome of Drug Treatment] vincristine/cb [Drug Combination] vincristine/dt [Drug Therapy] *cancer staging cohort analysis comparative effectiveness controlled study female *follicular lymphoma / *drug therapy / *radiotherapy follow up human human tissue lymph node metastasis / complication maintenance therapy major clinical study male monotherapy multimodality cancer therapy overall survival *positron emission tomography-computed tomography priority journal progression free survival radiation dose retrospective study distant metastasis / complication survival time systemic therapy treatment failure treatment outcome watchful waiting survival rate adult aged Article bone marrow biopsy cancer combination chemotherapy cancer immunotherapy cancer mortality cancer radiotherapy cancer recurrence |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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