The optimal strategy for early surveillance after first complete response is unclear in Hodgkin lymphoma. Thus, we compared the various follow-up strategies in a multicenter study. All the included patients had a negative positron emission tomography/computed tomography at the end of induction therapy. From January 2007 to January 2018, we recruited 640 patients from 15 centers in Spain. Comparing the groups in which serial imaging were performed, the clinical/analytical follow-up group was exposed to significantly fewer imaging tests and less radiation. With a median follow-up of 127 months, progression-free survival at 60 months of the entire series was 88% and the overall survival was 97%. No significant differences in survival or progression-free survival were found among the various surveillance strategies. This study suggests that follow-up approaches with imaging in Hodgkin lymphoma provide no benefits for patient survival, and we believe that clinical/analytical surveillance for this group of patients could be the best course of action.
A propensity-matched cohort of 2029 patients treated with BR and 2029 patients treated with R-CVP/CHOP were included. The median age of patients was 64 years and 48% were female in the cohort. A majority of patients had a diagnosis of follicular lymphoma (59.3% of patients treated with BR, 59.7% of patients treated with R-CVP/CHOP, p = 0.88). Median follow-up time was 41 and 87 months for patients treated with BR and R-CVP/CHOP, respectively.In this well-matched cohort, BR was associated with a significant improvement in survival compared to R-CVP/CHOP (HR 0.76, 95% CI 0.67-0.88, p < 0.01). Five-year OS was 80% and 75% for patients treated with BR and R-CVP/CHOP, respectively (Figure 1). A total of 974 patients died during the follow-up period (331 treated with BR, 643 treated with R-CVP/CHOP), of which 875 had causes of death available. A majority of patients in both groups died from lymphoma (63.2% treated with BR, 66.4% treated with R-CVP/CHOP). Death from secondary malignancies was less common (11.8% treated with BR, 12.8% treated with R-CVP/CHOP). Few patients died from infection (6.2% treated with BR, 3.2% treated with R-CVP/CHOP). Conclusions:Our study demonstrates improved OS with BR compared to R-CVP/CHOP for patients with previously untreated indolent lymphoma. Cause of death in both cohorts was most frequently attributable to lymphoma. This supports BR as the standard of care for treatment of symptomatic indolent lymphoma.
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