PURPOSE: We previously reported that ∼30% of patients with localized follicular lymphoma (FL) staged by 18F-fluorodeoxyglucose positron emission tomography-computed tomography receiving primary radiation therapy (RT) will relapse within 5 years. We sought to report outcomes for those who relapsed. METHODS AND MATERIALS: We conducted a multicenter, retrospective study of patients aged ≥18 years who received RT ≥ 24 Gy for stage I to II, grade 1 to 3A FL, staged with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography. Observation was defined as >6 months without treatment from relapse. Overall survival (OS) and freedom from progression (FFP) were estimated with Kaplan-Meier analysis and univariable and multivariable analyses with Cox regression. RESULTS: Of 512 patients with median follow-up of 52 months, 149 (29.1%) developed recurrent lymphoma at a median of 23 months (range, 1-143) after primary RT. Median follow-up was 33 months after relapse. Three-year OS was 91.4% after recurrence. OS was significantly worse for those with relapse ≤12 months from date of diagnosis versus all others-88.7% versus 97.6%, respectively (P = .01)-and remained significantly worse on multivariable analyses (follicular lymphoma international prognostic index-adjusted hazard ratio, 3.61; P = .009). Histology at relapse included 93 indolent (grade 1-3A), 3 FL grade 3B/not otherwise specified, and 18 diffuse large B-cell lymphoma; 35 patients did not undergo biopsy. Of those with follow-up ≥3 months who underwent biopsy (n = 74) or had presumed (n = 23) indolent recurrence, 58 patients (59.8%) were observed, 19 (19.6%) had systemic therapy, 16 (16.5%) had RT, and 4 (4.1%) had systemic therapy + RT. For patients with indolent recurrences that were observed, 3-year FFP or freedom from treatment was 56.6% (median, 48 months). For all patients with biopsied/presumed indolent recurrence receiving salvage treatment (n = 59, including 20 initially observed) 3-year FFP was 73.9%. CONCLUSIONS: Prognosis for patients with relapsed FL after primary radiation therapy is excellent, supporting the role of primary radiation in the management of early stage disease. Patients with localized FL treated with primary RT who experience early relapse (<12 months) have inferior survival compared with those with longer disease-free interval.
PURPOSE: We previously reported that ∼30% of patients with localized follicular lymphoma (FL) staged by 18F-fluorodeoxyglucose positron emission tomography-computed tomography receiving primary radiation therapy (RT) will relapse within 5 years. We sought to report outcomes for those who relapsed. METHODS AND MATERIALS: We conducted a multicenter, retrospective study of patients aged ≥18 years who received RT ≥ 24 Gy for stage I to II, grade 1 to 3A FL, staged with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography. Observation was defined as >6 months without treatment from relapse. Overall survival (OS) and freedom from progression (FFP) were estimated with Kaplan-Meier analysis and univariable and multivariable analyses with Cox regression. RESULTS: Of 512 patients with median follow-up of 52 months, 149 (29.1%) developed recurrent lymphoma at a median of 23 months (range, 1-143) after primary RT. Median follow-up was 33 months after relapse. Three-year OS was 91.4% after recurrence. OS was significantly worse for those with relapse ≤12 months from date of diagnosis versus all others-88.7% versus 97.6%, respectively (P = .01)-and remained significantly worse on multivariable analyses (follicular lymphoma international prognostic index-adjusted hazard ratio, 3.61; P = .009). Histology at relapse included 93 indolent (grade 1-3A), 3 FL grade 3B/not otherwise specified, and 18 diffuse large B-cell lymphoma; 35 patients did not undergo biopsy. Of those with follow-up ≥3 months who underwent biopsy (n = 74) or had presumed (n = 23) indolent recurrence, 58 patients (59.8%) were observed, 19 (19.6%) had systemic therapy, 16 (16.5%) had RT, and 4 (4.1%) had systemic therapy + RT. For patients with indolent recurrences that were observed, 3-year FFP or freedom from treatment was 56.6% (median, 48 months). For all patients with biopsied/presumed indolent recurrence receiving salvage treatment (n = 59, including 20 initially observed) 3-year FFP was 73.9%. CONCLUSIONS: Prognosis for patients with relapsed FL after primary radiation therapy is excellent, supporting the role of primary radiation in the management of early stage disease. Patients with localized FL treated with primary RT who experience early relapse (<12 months) have inferior survival compared with those with longer disease-free interval.
Authors: Kirit M Ardeshna; Wendi Qian; Paul Smith; Nivette Braganca; Lisa Lowry; Pip Patrick; June Warden; Lindsey Stevens; Christopher F E Pocock; Fiona Miall; David Cunningham; John Davies; Andrew Jack; Richard Stephens; Jan Walewski; Burhan Ferhanoglu; Ken Bradstock; David C Linch Journal: Lancet Oncol Date: 2014-03-04 Impact factor: 41.316
Authors: Jessica L Brady; Michael S Binkley; Carla Hajj; Monica Chelius; Karen Chau; Alex Balogh; Mario Levis; Andrea Riccardo Filippi; Michael Jones; Michael Mac Manus; Andrew Wirth; Masahiko Oguchi; Anders Krog Vistisen; Therese Youssef Andraos; Andrea K Ng; Berthe M P Aleman; Seo Hee Choi; Youlia Kirova; Sara Hardy; Gabriele Reinartz; Hans T Eich; Scott V Bratman; Louis S Constine; Chang-Ok Suh; Bouthaina Dabaja; Tarec C El-Galaly; David C Hodgson; Umberto Ricardi; Joachim Yahalom; Richard T Hoppe; N George Mikhaeel Journal: Blood Date: 2018-11-16 Impact factor: 22.113
Authors: Carla Casulo; Michelle Byrtek; Keith L Dawson; Xiaolei Zhou; Charles M Farber; Christopher R Flowers; John D Hainsworth; Matthew J Maurer; James R Cerhan; Brian K Link; Andrew D Zelenetz; Jonathan W Friedberg Journal: J Clin Oncol Date: 2015-06-29 Impact factor: 44.544
Authors: P Brice; Y Bastion; E Lepage; N Brousse; C Haïoun; P Moreau; N Straetmans; H Tilly; I Tabah; P Solal-Céligny Journal: J Clin Oncol Date: 1997-03 Impact factor: 44.544
Authors: Philippe Solal-Céligny; 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 Journal: J Clin Oncol Date: 2012-09-24 Impact factor: 44.544
Authors: Abdulwahab J Al-Tourah; Karamjit K Gill; Mukesh Chhanabhai; Paul J Hoskins; Richard J Klasa; Kerry J Savage; Laurie H Sehn; Tamara N Shenkier; Randy D Gascoyne; Joseph M Connors Journal: J Clin Oncol Date: 2008-10-06 Impact factor: 44.544
Authors: P W Johnson; A Z Rohatiner; J S Whelan; C G Price; S Love; J Lim; J Matthews; A J Norton; J A Amess; T A Lister Journal: J Clin Oncol Date: 1995-01 Impact factor: 44.544
Authors: É Grignano; B Deau-Fischer; G Loganadane; M Breton; B Burroni; D Bouscary; Y M Kirova Journal: Cancer Radiother Date: 2018-02-22 Impact factor: 1.018
Authors: Nathan H Fowler; Guifang Chen; Stephen Lim; Stephanie Manson; Qiufei Ma; Frank Yunfeng Li Journal: J Health Econ Outcomes Res Date: 2020-09-04
Authors: Melissa Lumish; Lorenzo Falchi; Brandon S Imber; Michael Scordo; Gottfried von Keudell; Erel Joffe Journal: J Hematol Oncol Date: 2021-01-06 Impact factor: 17.388
Authors: Andrea C Lo; Lyndon P James; Anca Prica; Adam Raymakers; Stuart Peacock; Melody Qu; Alex V Louie; Kerry J Savage; Laurie H Sehn; David Hodgson; Joanna C Yang; Hans T T Eich; Andrew Wirth; M G Myriam Hunink Journal: J Nucl Med Date: 2021-08-19 Impact factor: 10.057
Authors: Imke E Karsten; Gabriele Reinartz; Michaela Pixberg; Kai Kröger; Michael Oertel; Birte Friedrichs; Georg Lenz; Hans Theodor Eich Journal: Biomedicines Date: 2021-05-17
Authors: Brandon S Imber; Karen W Chau; Jasme Lee; Jisun Lee; Dana L Casey; Joanna C Yang; N Ari Wijentunga; Annemarie Shepherd; Carla Hajj; Shunan Qi; Monica R Chelius; Paul A Hamlin; M Lia Palomba; Erel Joffe; Zhigang Zhang; Andrew D Zelenetz; Gilles A Salles; Joachim Yahalom Journal: Blood Adv Date: 2021-10-26