Treatment strategies for early-stage follicular lymphoma

This study compared the outcomes associated with various treatments for early-stage follicular lymphoma. This study concluded that survival was similar with watchful waiting compared to other early treatments.

Follicular lymphoma (FL) is the most common form of slow-growing non-Hodgkin lymphoma. Less than 20% of patients are diagnosed at an early stage. Because this number is so low, the best treatment option is not clear. Common options include radiation, radiation plus chemotherapy, or watchful waiting. Watchful waiting involves monitoring disease growth without giving treatment. Rituximab (Rituxan) has also become an important treatment option. It is not clear which treatment is most effective in early-stage FL.

This study reviewed the records of 145 patients with stage I or II FL. 36 patients underwent watchful waiting. 21 patients were treated with radiation alone. 26 patients were treated with chemotherapy alone. 7 patients were treated with rituximab alone. 18 patients were treated with a combination of chemotherapy and radiation. 36 patients were treated with a combination of chemotherapy and rituximab. Patients were followed for an average of 7 years.

The rate of complete remission (CR, no sign of active disease) was 57.1% for rituximab, 69% for chemotherapy, and 81% for radiation. The CR rate for chemotherapy plus rituximab was 75%. It was 95% for chemotherapy plus radiation.

The relapse rate was significantly lower for chemotherapy plus rituximab (40%) compared to radiation alone (90.5%) or radiation plus chemotherapy (84%).

There were no significant differences in overall survival (OS, time from treatment until death from any cause) based on treatment type, including watchful waiting. OS at 7.5 years ranged from 66% for radiation alone, 72% for watchful waiting, to 100% for rituximab alone.

60% of patients treated with chemotherapy plus rituximab were progression free at 7.5 years. The rates for other treatments ranged from 19% to 26%.

This study concluded that survival rates were similar regardless of treatment type. The authors suggested that watchful waiting may be an appropriate option for some FL patients with low-tumor burden.