Effectiveness of first-line management strategies for stage I follicular lymphoma: Analysis of the National Lymphocare Study

Jonathan W. Friedberg, Michelle Byrtek, Brian K. Link, Christopher Flowers, Michael Taylor, John Hainsworth, James R. Cerhan, Andrew D. Zelenetz, Jamie Hirata, Thomas P Miller

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

Purpose: The optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT). Patients and Methods: We analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database. Results: Of 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28%), XRT (27%), observation (17%), systemic therapy + XRT (13%), rituximab monotherapy (12%), and other (3%). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21% of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival. Conclusion: In this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.

Original languageEnglish (US)
Pages (from-to)3368-3375
Number of pages8
JournalJournal of Clinical Oncology
Volume30
Issue number27
DOIs
StatePublished - Sep 20 2012

Fingerprint

Follicular Lymphoma
Disease-Free Survival
Guidelines
Therapeutics
Whole Body Imaging
Histology
Radiotherapy
Bone Marrow
Tomography

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Effectiveness of first-line management strategies for stage I follicular lymphoma : Analysis of the National Lymphocare Study. / Friedberg, Jonathan W.; Byrtek, Michelle; Link, Brian K.; Flowers, Christopher; Taylor, Michael; Hainsworth, John; Cerhan, James R.; Zelenetz, Andrew D.; Hirata, Jamie; Miller, Thomas P.

In: Journal of Clinical Oncology, Vol. 30, No. 27, 20.09.2012, p. 3368-3375.

Research output: Contribution to journalArticle

Friedberg, JW, Byrtek, M, Link, BK, Flowers, C, Taylor, M, Hainsworth, J, Cerhan, JR, Zelenetz, AD, Hirata, J & Miller, TP 2012, 'Effectiveness of first-line management strategies for stage I follicular lymphoma: Analysis of the National Lymphocare Study', Journal of Clinical Oncology, vol. 30, no. 27, pp. 3368-3375. https://doi.org/10.1200/JCO.2011.40.6546
Friedberg, Jonathan W. ; Byrtek, Michelle ; Link, Brian K. ; Flowers, Christopher ; Taylor, Michael ; Hainsworth, John ; Cerhan, James R. ; Zelenetz, Andrew D. ; Hirata, Jamie ; Miller, Thomas P. / Effectiveness of first-line management strategies for stage I follicular lymphoma : Analysis of the National Lymphocare Study. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 27. pp. 3368-3375.
@article{d0c996007b814730857656ed7fea3cfd,
title = "Effectiveness of first-line management strategies for stage I follicular lymphoma: Analysis of the National Lymphocare Study",
abstract = "Purpose: The optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT). Patients and Methods: We analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database. Results: Of 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28{\%}), XRT (27{\%}), observation (17{\%}), systemic therapy + XRT (13{\%}), rituximab monotherapy (12{\%}), and other (3{\%}). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21{\%} of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival. Conclusion: In this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.",
author = "Friedberg, {Jonathan W.} and Michelle Byrtek and Link, {Brian K.} and Christopher Flowers and Michael Taylor and John Hainsworth and Cerhan, {James R.} and Zelenetz, {Andrew D.} and Jamie Hirata and Miller, {Thomas P}",
year = "2012",
month = "9",
day = "20",
doi = "10.1200/JCO.2011.40.6546",
language = "English (US)",
volume = "30",
pages = "3368--3375",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "27",

}

TY - JOUR

T1 - Effectiveness of first-line management strategies for stage I follicular lymphoma

T2 - Analysis of the National Lymphocare Study

AU - Friedberg, Jonathan W.

AU - Byrtek, Michelle

AU - Link, Brian K.

AU - Flowers, Christopher

AU - Taylor, Michael

AU - Hainsworth, John

AU - Cerhan, James R.

AU - Zelenetz, Andrew D.

AU - Hirata, Jamie

AU - Miller, Thomas P

PY - 2012/9/20

Y1 - 2012/9/20

N2 - Purpose: The optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT). Patients and Methods: We analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database. Results: Of 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28%), XRT (27%), observation (17%), systemic therapy + XRT (13%), rituximab monotherapy (12%), and other (3%). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21% of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival. Conclusion: In this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.

AB - Purpose: The optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT). Patients and Methods: We analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database. Results: Of 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28%), XRT (27%), observation (17%), systemic therapy + XRT (13%), rituximab monotherapy (12%), and other (3%). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21% of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival. Conclusion: In this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.

UR - http://www.scopus.com/inward/record.url?scp=84866745624&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866745624&partnerID=8YFLogxK

U2 - 10.1200/JCO.2011.40.6546

DO - 10.1200/JCO.2011.40.6546

M3 - Article

C2 - 22915662

AN - SCOPUS:84866745624

VL - 30

SP - 3368

EP - 3375

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 27

ER -