The long term follow-up of early stage follicular lymphoma treated with radiotherapy, chemotherapy or combined modality treatment

Sancho, Juan‐Manuel; García, Olga; Mercadal, Santiago; Pomares, Helena; Fernández-Álvarez, Rubén; González‐Barca, Eva; Tapia, Gustavo; González-García, Esther; Moreno, Miriam; Domingo‐Domènech, Eva; Sorigué, Marc; Navarro, José Tomás; Motlló, Cristina; Fernández-de-Sevilla, Alberto; Feliú, Evarist; Ribera, Josep‐Marǐa

doi:10.1016/j.leukres.2015.05.009

Cited by 17 publications

(13 citation statements)

References 38 publications

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“…About 20% of FL patients are diagnosed in early stage (Armitage & Weisenburger, ). Radiation therapy (RT) is the treatment of choice and results in 10‐year overall survival (OS) rates of 60–80%, with a median survival of approximately 19 years (Mac Manus & Hoppe, ; Campbell et al , ; Pugh et al , ; Sancho et al , ). An initial observational strategy has also been considered (Friedberg et al , ; Barzenje et al , ).…”

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Minimal residual disease monitoring in early stage follicular lymphoma can predict prognosis and drive treatment with rituximab after radiotherapy

et al. 2019

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Since 2000, we have investigated 67 consecutive patients with stage I/II follicular lymphoma (FL) for the presence of BCL2/IGH rearrangements by polymerase chain reaction (PCR), real time quantitative PCR (RQ-PCR) and digital droplet PCR (ddPCR). All patients were treated with involvedfield radiotherapy (IF-RT) (24-30 Gy). From 2005, patients with minimal residual disease (MRD) after IF-RT received rituximab (R) (375 mg/m 2 , 4 weekly administrations). The median follow-up is 82 months . At diagnosis, 72% of patients were BCL2/IGH+. Progression-free survival (PFS) was significantly better in patients with undetectable/low levels (<10 À5 ) of circulating BCL2/IGH+ cells at diagnosis and in those who were persistently MRDÀ during follow-up (P = 0Á0038). IF-RT induced an MRDÀ status in 50% of cases; 16/19 (84%) MRD+ patients after IF-RT became MRDÀ after R treatment. A significantly longer PFS was observed in MRD+ patients treated with R compared to untreated MRD+ patients (P = 0Á049). In early stage FL, both circulating levels of BCL2/IGH+ cells at diagnosis and MRD status during follow-up bear prognostic implications. Standard IF-RT fails to induce an MRD-negative status in half of patients. Most patients become MRDÀ following treatment with R and this is associated with a significantly better PFS.

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Minimal residual disease monitoring in early stage follicular lymphoma can predict prognosis and drive treatment with rituximab after radiotherapy

et al. 2019

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“…The incidence increases with the age and globally it is a common disease with an important repercussion in the health system and in the quality of life of patients . The historical median overall survival (OS) is around 10 yr; however, for young patients under 40 yr with the improvements in immune chemotherapy schedules, supportive care and the use of target therapy, the survival of the treated patients has been improved and some reports inform an estimated survival of 80–90% at 5 yr from therapy . The use of the combined regimen of rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (R‐CHOP) had been the most spread used schedule of therapy, but other schemes have been raising like rituximab–bendamustine and so on ; at the same time, consolidation and maintenance approaches like rituximab maintenance every 8 wk during 2 yr or consolidation with radioimmunotherapy (RIT) with 90‐yttrium‐ibritumomab‐tiuxetan (ZEVALIN ® ; Spectrum Pharmaceuticals.…”

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Long‐term complication in follicular lymphoma: assessing the risk of secondary neoplasm in 242 patients treated or not with 90‐yttrium‐ibritumomab‐tiuxetan

Andrade‐Campos

Liévano

Espinosa-Lara

et al. 2016

European J of Haematology

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“…Indeed, some studies have reported that PFS or disease-specific survival improved more after systemic chemotherapy than after irradiation alone or with a WW strategy. 11,31 However, other studies have not found such improvements; 21,24 therefore, the importance of systemic therapy remains debatable. Recently, R has become the preferred candidate for systemic therapy in terms of adverse events such as SPM.…”

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Clinical management and outcomes of completely resected stage I follicular lymphoma

Yokohama

Hashimoto

Takizawa

et al. 2018

JCEH

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JC EH lin xp ematopathol Original Article INTRODUCTIONFollicular lymphoma (FL) is the second-most common type of non-Hodgkin lymphoma in the United States and Europe, 1,2 and is increasing in frequency even in Japan. 3 FL is characterized by indolent clinical behavior and subsequent histological transformation linked with an aggressive clinical course and poor outcomes. A substantial number of patients exhibit no clinical symptoms and do not need immediate treatment irrespective of clinical stage, although FL is recognized as an incurable malignant disease.The treatment modality for patients with malignant lymphoma is generally selected based on clinical stage being early or advanced. 4 For early-stage FL, involved-field irradiation therapy is recommended by published guidelines. 5,6 Moreover, irradiation is the only treatment strategy to demonstrate any advantage in terms of overall survival, although the evidence for this was obtained from retrospective studies. 7,8 However, the reality is that several treatment strategies have been applied for patients with early-stage FL, including combined-modality therapy (CMT), irradiation alone, watch-and-wait (WW), and more recently, rituximab (R)-containing chemotherapy or R monotherapy, 9-11 probably because recommendations have been based on relatively small, retrospective studies from a single center. Of these, 18 patients underwent total resection after diagnostic tissue biopsy. We used 18 F-fluorodeoxyglucose positron emission CT for staging assessment in 13 of 18 patients (72.2%). The median age was 56.5 years. Six patients (33.3%) were male. The soluble interleukin-2 receptor alpha concentration was significantly lower than in patients with residual disease. Among these 18 patients, 7 patients (38.9%) were treated with a "watch-and-wait" (WW) policy, 7 (38.9%) were treated with involved-field irradiation, and 4 (22.2%) received systemic chemotherapy. Patients with resected disease were treated with significantly different strategies from those with residual disease (p = 0.0026). Five patients experienced relapse during follow-up (median follow-up: 48.2 months). All relapses were distant from the primary site, irrespective of treatment strategy. Among all stage I patients, disease resection was not a significant factor for survival (p = 0.9294). Collectively, the choice of treatment strategy was significantly influenced by patient status. Resection status was not significantly associated with survival after several treatment strategies.

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The long term follow-up of early stage follicular lymphoma treated with radiotherapy, chemotherapy or combined modality treatment

Cited by 17 publications

References 38 publications

Minimal residual disease monitoring in early stage follicular lymphoma can predict prognosis and drive treatment with rituximab after radiotherapy

Minimal residual disease monitoring in early stage follicular lymphoma can predict prognosis and drive treatment with rituximab after radiotherapy

Long‐term complication in follicular lymphoma: assessing the risk of secondary neoplasm in 242 patients treated or not with 90‐yttrium‐ibritumomab‐tiuxetan

Clinical management and outcomes of completely resected stage I follicular lymphoma

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