What first-line treatments are effective for stage I follicular lymphoma?

This study compared the outcomes of different treatment options for stage 1 follicular lymphoma (FL). This study concluded that different treatment approaches were all associated with good outcomes.

FL is the second most common form of non-Hodgkin lymphoma diagnosed in the United States. 26% of patients are diagnosed in stage 1. This refers to a single involved lymph node site and no bone marrow involvement. The standard treatment recommendation for this stage of FL is radiation. Few trials, however, have compared the outcomes of patients treated with radiation or other treatment options.

This study examined the records of 471 patients with stage 1 FL included in a lymphoma database. Patients were divided into two groups depending on how their disease had been staged. Rigorously staged (RS) patients underwent a bone marrow biopsy and some type of scan. A bone marrow biopsy is a test that removes a small amount of bone to look for lymphoma cells in the bone marrow. Scans could include a CT scan, an FDG-PET scan (measures glucose uptake by cells to identify cancer activity), or both. Non-rigorously staged (NRS) patients were missing either biopsy or imaging. Patients were followed for an average of 57 months.

RS patients were more likely to have been treated with rituximab plus chemotherapy (28%) than NRS patients (17%). RS patients were more likely to have been treated with chemotherapy and radiation (13%) compared to NRS patients (6%). NRS patients were more likely to undergo watchful waiting (no active treatment, 39%) than RS patients (17%).

The risk of disease progression was 37% lower in RS patients compared to NRS patients. 21% of RS patients experienced disease progression over 57 months. Treatment with radiation alone was associated with a higher risk of disease progression. There were no differences in overall survival (time from treatment until death from any cause).

This study concluded that different treatment approaches were all associated with good outcomes in patients with stage I FL. The authors suggested that radiation may not need to be the standard treatment option for these patients.