PURPOSE: Advanced-stage follicular lymphoma is considered incurable. The pace of improvements in treatment has been slow. This article analyzes five sequential cohorts of patients with stage IV follicular lymphoma treated between 1972 and 2002. METHODS: Five consecutive studies (two were randomized trials) involving 580 patients were analyzed for overall survival (OS), failure-free survival (FFS), and survival after first relapse. A proportional hazards analysis, and subset analyses using the follicular lymphoma international prognostic index (FLIPI) score were performed. Treatment regimens included: cyclophosphamide, doxorubicin, vincristine, prednisone, bleomycin (CHOP-Bleo); CHOP-Bleo followed by interferon alfa (IFN-alpha); a rotation of three regimens (alternating triple therapy), followed by IFN-alpha; fludarabine, mitoxantrone, dexamethasone (FND) followed by IFN-alpha; and FND plus delayed versus concurrent rituximab followed by IFN-alpha. RESULTS: Improvements in 5-year OS (from 64% to 95%) and FFS (from 29% to 60%) indicate steady progress, perhaps partly due to more effective salvage therapies, but the FFS data also indicate improved front-line therapies; these observations held true after controlling for differences in prognostic factors among the cohorts. The FLIPI model adds rigor to and facilitates comparisons among the different cohorts. An unexpected finding in this study was a trend toward an apparent FFS plateau. CONCLUSION: Evolving therapy, including the incorporation of biologic agents, has led to stepwise significant outcome improvements for patients with advanced-stage follicular lymphoma. The apparent plateau in the FFS curve, starting approximately 8 to 10 years from the beginning of treatment, raises the issue of the potential curability of these patients.
PURPOSE: Advanced-stage follicular lymphoma is considered incurable. The pace of improvements in treatment has been slow. This article analyzes five sequential cohorts of patients with stage IV follicular lymphoma treated between 1972 and 2002. METHODS: Five consecutive studies (two were randomized trials) involving 580 patients were analyzed for overall survival (OS), failure-free survival (FFS), and survival after first relapse. A proportional hazards analysis, and subset analyses using the follicular lymphoma international prognostic index (FLIPI) score were performed. Treatment regimens included: cyclophosphamide, doxorubicin, vincristine, prednisone, bleomycin (CHOP-Bleo); CHOP-Bleo followed by interferon alfa (IFN-alpha); a rotation of three regimens (alternating triple therapy), followed by IFN-alpha; fludarabine, mitoxantrone, dexamethasone (FND) followed by IFN-alpha; and FND plus delayed versus concurrent rituximab followed by IFN-alpha. RESULTS: Improvements in 5-year OS (from 64% to 95%) and FFS (from 29% to 60%) indicate steady progress, perhaps partly due to more effective salvage therapies, but the FFS data also indicate improved front-line therapies; these observations held true after controlling for differences in prognostic factors among the cohorts. The FLIPI model adds rigor to and facilitates comparisons among the different cohorts. An unexpected finding in this study was a trend toward an apparent FFS plateau. CONCLUSION: Evolving therapy, including the incorporation of biologic agents, has led to stepwise significant outcome improvements for patients with advanced-stage follicular lymphoma. The apparent plateau in the FFS curve, starting approximately 8 to 10 years from the beginning of treatment, raises the issue of the potential curability of these patients.
Authors: Stephen J Schuster; Sattva S Neelapu; Barry L Gause; John E Janik; Franco M Muggia; Jon P Gockerman; Jane N Winter; Christopher R Flowers; Daniel A Nikcevich; Eduardo M Sotomayor; Dean S McGaughey; Elaine S Jaffe; Elise A Chong; Craig W Reynolds; Donald A Berry; Carlos F Santos; Mihaela A Popa; Amy M McCord; Larry W Kwak Journal: J Clin Oncol Date: 2011-05-31 Impact factor: 44.544
Authors: H R Junlén; S Peterson; E Kimby; S Lockmer; O Lindén; H Nilsson-Ehle; M Erlanson; H Hagberg; A Rådlund; O Hagberg; B E Wahlin Journal: Leukemia Date: 2014-08-25 Impact factor: 11.528
Authors: Derville O'Shea; Ciarán O'Riain; Manu Gupta; Rachel Waters; Youwen Yang; David Wrench; John Gribben; Andreas Rosenwald; German Ott; Lisa M Rimsza; Harald Holte; Jean-Baptiste Cazier; Nathalie A Johnson; Elias Campo; Wing C Chan; Randy D Gascoyne; Bryan D Young; Louis M Staudt; T Andrew Lister; Jude Fitzgibbon Journal: Blood Date: 2009-01-13 Impact factor: 22.113
Authors: Daryl Tan; Sandra J Horning; Richard T Hoppe; Ronald Levy; Saul A Rosenberg; Bronislava M Sigal; Roger A Warnke; Yasodha Natkunam; Summer S Han; Alan Yuen; Sylvia K Plevritis; Ranjana H Advani Journal: Blood Date: 2013-06-18 Impact factor: 22.113