Evaluating the impact of watchful waiting on the outcomes of patients with follicular lymphoma

This study investigated the impact of watchful waiting on the outcomes of patients with follicular lymphoma (FL). This study concluded that these patients had a higher risk of disease transformation compared to patients who receive immediate treatment.

About 15 – 30% of patients with FL have advanced-stage (stage 3 – 4) disease, but a low tumor burden. These patients are often managed with watchful waiting. Watchful waiting is a way of monitoring cancer that is not causing symptoms. Anti-cancer therapy is then required when symptoms develop.

However, watchful waiting has been associated with a risk of organ dysfunction and lymphoma transformation (development of aggressive disease). 1 in 4 patients with FL develop these long-term complications, which are associated with poorer survival. The impact of these complications on the long-term outcomes of patients with FL under watchful waiting remains under investigation.

This study involved the records of 238 patients with FL. These patients were initially managed with watchful waiting. 71% of patients had disease progression and required chemotherapy. Patients were followed-up for an average of 8.2 years.

Overall, the 10-year overall survival (patients still alive 10 years later; OS) was 81.2%.

24.4% of all patients developed significant organ dysfunction or lymphoma transformation at an average of 29.9 months after chemotherapy. Of these, 96.6% received chemotherapy. The 10-year OS was significantly worse for patients who developed organ dysfunction (2.10-fold lower OS) or transformed disease (2.88-fold lower OS).

In a separate analysis, this patient population was compared to 236 patients who received immediate chemotherapy containing rituximab (Rituxan). The 10-year OS was 84.0% for these patients.

The 10-year OS was significantly higher for immediately-treated patients compared to those who experienced disease progression under watchful waiting (84.0% vs. 74.4%). The 10-year risk of lymphoma transformation was also significantly higher in the watchful waiting group (25.5% vs. 6.3%).

This study concluded that patients with FL under watchful waiting had a higher risk of disease transformation compared to those who received immediate treatment. The authors suggest that these patients should be monitored and considered for early therapy if they experience disease progression.

This study was retrospective, meaning it looked back in time to analyze data. The long-term consequences of organ dysfunction in patients with FL warrant further investigation.