Watchful waiting in low-tumor burden follicular lymphoma in the rituximab era: Results of an F2-study database

Philippe Solal-Ceĺigny*, Monica Bellei, Luigi Marcheselli, Emanuela Anna Pesce, Stefano Pileri, Peter McLaughlin, Stefano Luminari, Barbara Pro, Silvia Montoto, Andrés J M Ferreri, Eric Deconinck, Noël Milpied, Leo I. Gordon, Massimo Federico

*Corresponding author for this work

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76 Scopus citations

Abstract

Purpose: Patients with follicular lymphoma (FL) registered in the F2-study and initially managed without treatment were analyzed to describe the presentation and outcome of a watch and wait (W&W) strategy in the rituximab era, to identify parameters for initiating treatment, and to evaluate whether initial W&W could have deleterious effects on treatment efficacy after progression or relapse. Patients and Methods: Between 2003 and 2005, 120 patients selected from the 1,093 treatment-naive patients with FL in the F2-study cohort were initially managed expectantly (W&W), and 107 patients were assessed. Most of these patients (80%) had disseminated disease with a low tumor burden according to Groupe d'Etudes des Lymphomes Folliculaires criteria. Results: After a median follow-up of 64 months, treatment was initiated in 54 patients (50%), with a median delay of 55 months for the entire cohort. In a univariate analysis, involvement of more than four nodal areas (hazard ratio [HR], 2.26) and serum albumin less than 3.5 g/dL (HR, 3.51) were predictive of a shorter time to lymphoma treatment initiation. In a multivariate analysis, only involvement of more than four nodal areas remained significant (HR, 2.32). The 4-year freedom from treatment failure (FFTF) rate of W&W patients (79%; 95% CI, 69% to 85%) was not inferior to that of a subgroup of 242 patients from the F2-study cohort with good prognosis characteristics who were initially treated with a rituximab-based regimen (69%; 95% CI, 61% to 76%; P = .103). Conclusion: In the rituximab era, patients with FL in a selected prognostically favorable group can still be managed with W&W. W&W does not seem to have detrimental effects on FFTF and overall survival rates after treatment.

Original languageEnglish (US)
Pages (from-to)3848-3853
Number of pages6
JournalJournal of Clinical Oncology
Volume30
Issue number31
DOIs
StatePublished - Nov 1 2012

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Solal-Ceĺigny, P., Bellei, M., Marcheselli, L., Pesce, E. A., Pileri, S., McLaughlin, P., Luminari, S., Pro, B., Montoto, S., Ferreri, A. J. M., Deconinck, E., Milpied, N., Gordon, L. I., & Federico, M. (2012). Watchful waiting in low-tumor burden follicular lymphoma in the rituximab era: Results of an F2-study database. Journal of Clinical Oncology, 30(31), 3848-3853. https://doi.org/10.1200/JCO.2010.33.4474