Sandra Lockmer1, Bjørn Østenstad1, Hans Hagberg1, Harald Holte1, Ann-Sofie Johansson1, Björn Engelbrekt Wahlin1, Karin Fahl Wader1, Chloé Beate Steen1, Peter Meyer1, Martin Maisenhølder1, Karin Ekström Smedby1, Peter Brown1, Eva Kimby1. 1. Sandra Lockmer, Björn Engelbrekt Wahlin, Karin Ekström Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Björn Engelbrekt Wahlin, and Karin Ekström Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Umeå, Sweden; Bjørn Østenstad and Harald Holte, Oslo University Hospital; Chloé Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University Hospital, Stavanger; Martin Maisenhølder, University Hospital of Northern Norway, Tromsø, Norway; and Peter Brown, Rigshospitalet, Copenhagen, Denmark.
Abstract
PURPOSE: For indolent lymphoma, the optimal timing, sequence, and choice of therapeutic regimens remain a matter of debate. In two Nordic Lymphoma Group randomized trials, symptomatic or clearly progressing patients were treated first line with a rituximab-containing regimen without chemotherapy. The purpose of this study was to assess long-term survival, risk of transformation, and need of new therapies. METHODS: Data were collected at cross-sectional follow-up for 321 patients with indolent lymphoma (84% with follicular lymphomas [FL]) included in one of two Nordic Lymphoma Group trials (accrual 1998 to 1999 and 2002 to 2008). All patients received first-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m2, and 148 were randomly allocated to the addition of interferon alfa-2a. Follow-up data were retrieved from initial trial databases and medical records on repeated clinical evaluations. RESULTS: At the end of follow-up, 73% of patients were alive, with a median follow-up after random assignment of 10.6 years. Among all, 36% (38% with FL) had never needed chemotherapy. For patients with FL who required new therapy within 24 months because of early disease progression, the 10-year survival rate was 59% versus 81% for those with longer remission. Interferon was not shown to improve long-term outcome. Transformation was diagnosed in 20% of all patients (2.4% per person-year) and in 18% with FL. An additional malignancy was found in 12%. CONCLUSION: Approximately one third of patients with symptomatic indolent lymphoma (30% with FL, 23% without FL) did not need new therapy in the long term after first-line rituximab without chemotherapy. In the entire cohort, 10-year survival was excellent with no major safety issues, which suggests that chemotherapy can be delayed safely in the majority of patients.
PURPOSE: For indolent lymphoma, the optimal timing, sequence, and choice of therapeutic regimens remain a matter of debate. In two Nordic Lymphoma Group randomized trials, symptomatic or clearly progressing patients were treated first line with a rituximab-containing regimen without chemotherapy. The purpose of this study was to assess long-term survival, risk of transformation, and need of new therapies. METHODS: Data were collected at cross-sectional follow-up for 321 patients with indolent lymphoma (84% with follicular lymphomas [FL]) included in one of two Nordic Lymphoma Group trials (accrual 1998 to 1999 and 2002 to 2008). All patients received first-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m2, and 148 were randomly allocated to the addition of interferon alfa-2a. Follow-up data were retrieved from initial trial databases and medical records on repeated clinical evaluations. RESULTS: At the end of follow-up, 73% of patients were alive, with a median follow-up after random assignment of 10.6 years. Among all, 36% (38% with FL) had never needed chemotherapy. For patients with FL who required new therapy within 24 months because of early disease progression, the 10-year survival rate was 59% versus 81% for those with longer remission. Interferon was not shown to improve long-term outcome. Transformation was diagnosed in 20% of all patients (2.4% per person-year) and in 18% with FL. An additional malignancy was found in 12%. CONCLUSION: Approximately one third of patients with symptomatic indolent lymphoma (30% with FL, 23% without FL) did not need new therapy in the long term after first-line rituximab without chemotherapy. In the entire cohort, 10-year survival was excellent with no major safety issues, which suggests that chemotherapy can be delayed safely in the majority of patients.
Authors: Chloé B Steen; Ellen Leich; June H Myklebust; Sandra Lockmer; Jillian F Wise; Björn E Wahlin; Bjørn Østenstad; Knut Liestøl; Eva Kimby; Andreas Rosenwald; Erlend B Smeland; Harald Holte; Ole Christian Lingjærde; Marianne Brodtkorb Journal: Haematologica Date: 2019-03-07 Impact factor: 9.941
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Authors: Raja Shanker; Syed Ziauddin Ahmed Zaidi; Nawal Faiez AlShehry; Fahad AlGhmlas; Ibraheem Hussein Motabi; Shahid Iqbal; Ahmad Ali Butt; Hassan AlShehri; Imran Khan Tailor; Syed Yasir Altaf; Mubarak AlGhamdi; Mohammed Marie; Mansour AlFayez; Kamal Al Zahrani; Mohammed Dwaimah; Tahani Al-Halouli; Wafaa Al-Shakweer; Maied Zaher AlShehery; Abdul Rehman Zia Zaidi; Atta Munawar Gill; Belal Mohammed Albtoosh; Musab Ahmed Journal: JMIR Form Res Date: 2021-11-12