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Title: | Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance. | Austin Authors: | Tobin, Joshua W D;Rule, Gabrielle;Colvin, Katherine;Calvente, Lourdes;Hodgson, David;Bell, Stephen;Dunduru, Chengetai;Gallo, James;Tsang, Erica S;Tan, Xuan;Wong, Jonathan;Pearce, Jessica;Campbell, Robert;Tneh, Shao;Shorten, Sophie;Ng, Melissa;Cochrane, Tara;Tam, Constantine S;Abro, Emad;Hawkes, Eliza A ;Hodges, Georgina;Kansara, Roopesh;Talaulikar, Dipti;Gilbertson, Michael;Johnston, Anna M;Savage, Kerry J;Villa, Diego;Morris, Kirk;Ratnasingam, Sumi;Janowski, Wojt;Kridel, Robert;Cheah, Chan Y;MacManus, Michael;Matigian, Nicholas;Mollee, Peter;Gandhi, Maher K;Hapgood, Greg | Affiliation: | Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Victoria, Australia Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia Department of Haematology, Canberra Hospital, Canberra, ACT, Australia Department of Haematology, Townsville Hospital, Townsville, QLD, Australia Department of Oncology, Austin Health, Heidelberg, Victoria, Australia Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada |
Issue Date: | 8-Oct-2019 | Publication information: | Blood advances 2019; 3(19): 2804-2811 | Abstract: | Management practices in early-stage (I/II) follicular lymphoma (FL) are variable and include radiation (RT), systemic therapy, or combined modality therapy (CMT). There is a paucity of data regarding maintenance rituximab in this cohort. We conducted an international retrospective study of patients with newly diagnosed early-stage FL staged with positron emission tomography (PET)-computed tomography and bone marrow biopsy. Three hundred sixty-five patients (stage I, n = 221), median age 63 years, treated from 2005-2017 were included, with a median follow-up of 45 months. Management included watchful waiting (WW; n = 85) and active treatment (n = 280). The latter consisted of RT alone (n = 171) or systemic therapy (immunochemotherapy [n = 63] or CMT [n = 46]). Forty-nine systemically treated patients received maintenance rituximab; 72.7% of stage I patients received RT alone, compared to 42.6% with stage II (P < .001). Active therapies yielded comparable overall response rates (P = .87). RT alone and systemic therapy without maintenance rituximab yielded similar progression-free survival (PFS) (hazard ratio [HR], 1.32; 95% confidence interval [CI], 0.77-2.34; P = .96). Maintenance rituximab improved PFS (HR, 0.24; 95% CI, 0.095-0.64; P = .017). The incidence of transformation was lower with systemic therapy compared to RT or WW (HR, 0.20; 95% CI, 0.070-0.61; P = .034). Overall survival was similar among all practices, including WW (P = .40). In the largest comparative assessment of management practices in the modern era, variable practices each resulted in similar excellent outcomes. Randomized studies are required to determine the optimal treatment in early-stage FL. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/21877 | DOI: | 10.1182/bloodadvances.2019000458 | ORCID: | 0000-0003-2974-8023 0000-0002-0376-2559 0000-0002-4625-3009 0000-0003-0287-7124 0000-0002-0900-5815 0000-0001-7735-9415 0000-0003-1000-5393 |
Journal: | Blood advances | PubMed URL: | 31570492 | Type: | Journal Article |
Appears in Collections: | Journal articles |
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