Selecting treatment regimen for newly diagnosed advanced stage follicular lymphoma.

The study evaluated the association of interleukin-2 (IL2) receptor (R) levels in the blood (a protein present on immune cells) in selecting a treatment for advanced-stage follicular lymphoma with a low tumor burden (FL-LTB). The study showed that patients with high IL-2R levels had better survival when treated with rituximab (Rituxan) in combination with chemotherapy compared to rituximab alone.

Follicular lymphoma (Fl) is a type of non-Hodgkin lymphoma (NHL), a cancer of B-cells (immune cells that produce antibodies). Often, patients with FL do not show any symptoms of the disease at diagnosis. This makes it known as a painless NHL. Watchful waiting is recommended to track symptoms. However, this often delays treatment for patients who require immediate treatment.

In patients with newly diagnosed FL, high levels of IL-2R in the blood are associated with poorer outcomes. Rituximab is an immunotherapy commonly recommended to patients with asymptomatic FL-LTB. However, it is not known if rituximab alone or in combination with chemotherapy increases overall survival in advanced-stage FL-LTB and if IL-2R levels can help decide the optimal treatment regimen for these patients. 

A total of 211 patients with FL who received rituximab were recruited in the study. The patients were then divided into two groups based on the levels of IL-2R at the time of treatment. Patients with IL-2R below1800 IU/ml were included in the low IL-2R group (group 1). Levels above 1800 IU/ml classified patients as high IL-2R (group 2). Patients in each group were further put into 2 different treatment groups. One group received rituximab alone (R group) and the other received rituximab with chemotherapy (R-chemo group). Patients were followed up for an average of 5.3 years.

In group 2, patients treated with R-chemo had a significantly higher survival after 5 years compared to those treated with R alone (94.4% vs 66.7%). In group 1, there was no significant difference in 5-year survival among patients treated with R alone (100%) and R-chemo (98.3%). 

The study concluded that rituximab with chemotherapy improves the outcomes of patients with advanced-stage FL and high IL-2R levels.  

There was an unequal distribution of patients between different groups. Also, the study was done on the Japanese population, therefore the results may not be applicable to other populations.