PURPOSE: Standard therapy for patients with stage I-II indolent lymphoma has been involved-field radiation therapy (IF-XRT), which achieves 10-year disease-free survival in 40% to 50% of patients, with many of these patients cured. We investigated the potential for combined-modality therapy to increase the disease-free survival for such patients. PATIENTS AND METHODS: A total of 102 eligible patients with stage I-II low grade lymphoma (International Working Formulation criteria) were enrolled from 1984 to 1992. Treatment comprised 10 cycles of risk-adapted chemotherapy (cyclophosphamide, vincristine, prednisone, bleomycin [COP-Bleo], and with doxorubicin added for some [CHOP-Bleo]) and 30 to 40 Gy IF-XRT. RESULTS: The patients' median age was 56 years (range, 28 to 77), with follicular histology in 83%, bulky disease (>/= 5 cm) in 24%, and stage II in 52%. There were no treatment-related deaths and 99% of patients attained complete remission. With a median follow-up of 10 years, the 10-year time to treatment failure and overall survival were 76% and 82%, respectively. For patients with follicular lymphoma, these figures were 72% and 80%, respectively. The only factor associated with treatment failure, for follicular lymphoma patients, was stage-modified International Prognostic Factors Index score (P =.02). None of 17 patients with diffuse small lymphocytic or mucosa-associated lymphoid tissue histology have relapsed. Elevated serum beta2-microglobulin was associated with shorter survival (P <.0001). The 10-year survival after relapse was 46%. There have been two cases of myelodysplasia and 12 other new malignancies, including four arising within radiation fields. CONCLUSION: With prolonged follow-up, combined-modality therapy with risk-adapted COP-/CHOP-Bleo and IF radiation has attained higher rates of disease control and survival than previously reported with IF-XRT alone. This apparent improvement is being further explored in an ongoing randomized trial.
PURPOSE: Standard therapy for patients with stage I-II indolent lymphoma has been involved-field radiation therapy (IF-XRT), which achieves 10-year disease-free survival in 40% to 50% of patients, with many of these patients cured. We investigated the potential for combined-modality therapy to increase the disease-free survival for such patients. PATIENTS AND METHODS: A total of 102 eligible patients with stage I-II low grade lymphoma (International Working Formulation criteria) were enrolled from 1984 to 1992. Treatment comprised 10 cycles of risk-adapted chemotherapy (cyclophosphamide, vincristine, prednisone, bleomycin [COP-Bleo], and with doxorubicin added for some [CHOP-Bleo]) and 30 to 40 Gy IF-XRT. RESULTS: The patients' median age was 56 years (range, 28 to 77), with follicular histology in 83%, bulky disease (>/= 5 cm) in 24%, and stage II in 52%. There were no treatment-related deaths and 99% of patients attained complete remission. With a median follow-up of 10 years, the 10-year time to treatment failure and overall survival were 76% and 82%, respectively. For patients with follicular lymphoma, these figures were 72% and 80%, respectively. The only factor associated with treatment failure, for follicular lymphomapatients, was stage-modified International Prognostic Factors Index score (P =.02). None of 17 patients with diffuse small lymphocytic or mucosa-associated lymphoid tissue histology have relapsed. Elevated serum beta2-microglobulin was associated with shorter survival (P <.0001). The 10-year survival after relapse was 46%. There have been two cases of myelodysplasia and 12 other new malignancies, including four arising within radiation fields. CONCLUSION: With prolonged follow-up, combined-modality therapy with risk-adapted COP-/CHOP-Bleo and IF radiation has attained higher rates of disease control and survival than previously reported with IF-XRT alone. This apparent improvement is being further explored in an ongoing randomized trial.
Authors: Joshua W D Tobin; Gabrielle Rule; Katherine Colvin; Lourdes Calvente; David Hodgson; Stephen Bell; Chengetai Dunduru; James Gallo; Erica S Tsang; Xuan Tan; Jonathan Wong; Jessica Pearce; Robert Campbell; Shao Tneh; Sophie Shorten; Melissa Ng; Tara Cochrane; Constantine S Tam; Emad Abro; Eliza Hawkes; Georgina Hodges; Roopesh Kansara; Dipti Talaulikar; Michael Gilbertson; Anna M Johnston; Kerry J Savage; Diego Villa; Kirk Morris; Sumi Ratnasingam; Wojt Janowski; Robert Kridel; Chan Y Cheah; Michael MacManus; Nicholas Matigian; Peter Mollee; Maher K Gandhi; Greg Hapgood Journal: Blood Adv Date: 2019-10-08
Authors: 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 Journal: J Clin Oncol Date: 2012-08-20 Impact factor: 44.544
Authors: M Ghielmini; U Vitolo; E Kimby; S Montoto; J Walewski; M Pfreundschuh; M Federico; P Hoskin; C McNamara; F Caligaris-Cappio; S Stilgenbauer; R Marcus; M Trneny; P Dreger; E Montserrat; M Dreyling Journal: Ann Oncol Date: 2012-11-21 Impact factor: 32.976