Influence of the watch and wait strategy on clinical outcomes of patients with follicular lymphoma in the rituximab era

Abstract

We analyzed the effects of the initial approach to patients with follicular lymphoma (FL) on outcomes in order to investigate whether the watch and wait (WW) strategy is still an acceptable approach in the rituximab era. We retrospectively analyzed 348 patients who were initially diagnosed with FL between 2000 and 2012. We compared the clinical outcomes of the WW cohort and immediate treatment cohort. Among 348 patients (median age of 57 years, range: 19–85), 101 were initially managed with WW and 247 were immediately treated. The median follow-up duration was 75 months (range: 7–169). The estimated median time to treatment failure (TTF) in the treatment following WW cohort and immediate treatment cohort were 92 months (95 % CI, 60.1–NA) and 77 months (95 % CI, 65.1–107.6), respectively, which were not significantly different (P = 0.272) . In a multivariate analysis, clinical stage was identified as a predictive factor of TTF (HR 1.19, 95 % CI, 1.03–1.38, P < 0.05). Neither overall survival rate nor cumulative risk of transformation between the WW cohort and immediate treatment cohort was significant. The results of the present study suggested that the WW strategy is still an acceptable approach for selected FL patients in the rituximab era.

Population-based epidemiological data of follicular lymphoma in Poland: 15 years of observation

“…There is a possibility that the newly diagnosed patients with high-grade FL “skip” the FL registration because they are usually qualified for the DLBCL, NOS treatment regimen. On the other hand, the low-grade FL cases frequently require only the “watch and wait” strategy, and physicians might neglect to report such cases 11 , 12 . Moreover, due to indolent behavior and long follow up periods, there can be multiple registrations of the same patient in various local registries.…”

Low number of intrafollicular T cells may predict favourable response to rituximab-based immuno-chemotherapy in advanced follicular lymphoma: a secondary analysis of a randomized clinical trial

“…In limited stages, radiation-based therapy is thought to have curative potential. In advanced stages, when patients lack symptoms, watch and wait strategy is applied, whereas chemotherapy is the therapy of choice when treatment is needed (Yuda et al 2016). Over decades, no progress had been seen in the therapy of advanced FL.…”

Transformed follicular lymphoma in the rituximab era: A report from the Spanish Lymphoma Oncology Group

“…In a study, patients were randomized to “watch and wait” or rituximab, and no differences were found between HT rates in the arms . Another recent study with patients who initially received treatment versus “watch and wait” found no differences in the rate of transformation . It should be noted that a significant limitation of the studies was the lack of sufficient events to analyze the transformation rates, due to the very short follow‐up.…”

“…20 Another recent study with patients who initially received treatment versus "watch and wait" found no differences in the rate of transformation. 21 It should be noted that a significant limitation of the studies was the lack of sufficient events to analyze the transformation rates, due to the very short follow-up. On the contrary, there are recent studies with a significant sample size and prolonged follow-up 7,16,18 that correlate "watch and wait" with an increased risk of transformation.…”