Watchful waiting in low-tumor burden follicular lymphoma in the rituximab era: Results of an F2-study database

Philippe Solal-Ceĺigny, 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

Research output: Contribution to journalArticle

Abstract

Purpose: Patients with follicular lymphoma (FL) registered in the F2-study and initially managed without treatment were analyzed to describe the presentation and outcome of a watch and wait (W&W) strategy in the rituximab era, to identify parameters for initiating treatment, and to evaluate whether initial W&W could have deleterious effects on treatment efficacy after progression or relapse. Patients and Methods: Between 2003 and 2005, 120 patients selected from the 1,093 treatment-naive patients with FL in the F2-study cohort were initially managed expectantly (W&W), and 107 patients were assessed. Most of these patients (80%) had disseminated disease with a low tumor burden according to Groupe d'Etudes des Lymphomes Folliculaires criteria. Results: After a median follow-up of 64 months, treatment was initiated in 54 patients (50%), with a median delay of 55 months for the entire cohort. In a univariate analysis, involvement of more than four nodal areas (hazard ratio [HR], 2.26) and serum albumin less than 3.5 g/dL (HR, 3.51) were predictive of a shorter time to lymphoma treatment initiation. In a multivariate analysis, only involvement of more than four nodal areas remained significant (HR, 2.32). The 4-year freedom from treatment failure (FFTF) rate of W&W patients (79%; 95% CI, 69% to 85%) was not inferior to that of a subgroup of 242 patients from the F2-study cohort with good prognosis characteristics who were initially treated with a rituximab-based regimen (69%; 95% CI, 61% to 76%; P = .103). Conclusion: In the rituximab era, patients with FL in a selected prognostically favorable group can still be managed with W&W. W&W does not seem to have detrimental effects on FFTF and overall survival rates after treatment.

Original languageEnglish
Pages (from-to)3848-3853
Number of pages6
JournalJournal of Clinical Oncology
Volume30
Issue number31
DOIs
Publication statusPublished - Nov 1 2012

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Watchful Waiting
Follicular Lymphoma
Tumor Burden
Databases
Treatment Failure
Cohort Studies
Therapeutics
Rituximab
Serum Albumin
Lymphoma
Multivariate Analysis
Survival Rate

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Solal-Ceĺigny, P., Bellei, M., Marcheselli, L., Pesce, E. A., Pileri, S., McLaughlin, P., ... Federico, M. (2012). Watchful waiting in low-tumor burden follicular lymphoma in the rituximab era: Results of an F2-study database. Journal of Clinical Oncology, 30(31), 3848-3853. https://doi.org/10.1200/JCO.2010.33.4474

Watchful waiting in low-tumor burden follicular lymphoma in the rituximab era : Results of an F2-study database. / Solal-Ceĺigny, Philippe; Bellei, Monica; Marcheselli, Luigi; Pesce, Emanuela Anna; Pileri, Stefano; McLaughlin, Peter; Luminari, Stefano; Pro, Barbara; Montoto, Silvia; Ferreri, Andrés J M; Deconinck, Eric; Milpied, Noël; Gordon, Leo I.; Federico, Massimo.

In: Journal of Clinical Oncology, Vol. 30, No. 31, 01.11.2012, p. 3848-3853.

Research output: Contribution to journalArticle

Solal-Ceĺigny, P, Bellei, M, Marcheselli, L, Pesce, EA, Pileri, S, McLaughlin, P, Luminari, S, Pro, B, Montoto, S, Ferreri, AJM, Deconinck, E, Milpied, N, Gordon, LI & Federico, M 2012, 'Watchful waiting in low-tumor burden follicular lymphoma in the rituximab era: Results of an F2-study database', Journal of Clinical Oncology, vol. 30, no. 31, pp. 3848-3853. https://doi.org/10.1200/JCO.2010.33.4474
Solal-Ceĺigny, Philippe ; Bellei, Monica ; Marcheselli, Luigi ; Pesce, Emanuela Anna ; Pileri, Stefano ; McLaughlin, Peter ; Luminari, Stefano ; Pro, Barbara ; Montoto, Silvia ; Ferreri, Andrés J M ; Deconinck, Eric ; Milpied, Noël ; Gordon, Leo I. ; Federico, Massimo. / Watchful waiting in low-tumor burden follicular lymphoma in the rituximab era : Results of an F2-study database. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 31. pp. 3848-3853.
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abstract = "Purpose: Patients with follicular lymphoma (FL) registered in the F2-study and initially managed without treatment were analyzed to describe the presentation and outcome of a watch and wait (W&W) strategy in the rituximab era, to identify parameters for initiating treatment, and to evaluate whether initial W&W could have deleterious effects on treatment efficacy after progression or relapse. Patients and Methods: Between 2003 and 2005, 120 patients selected from the 1,093 treatment-naive patients with FL in the F2-study cohort were initially managed expectantly (W&W), and 107 patients were assessed. Most of these patients (80{\%}) had disseminated disease with a low tumor burden according to Groupe d'Etudes des Lymphomes Folliculaires criteria. Results: After a median follow-up of 64 months, treatment was initiated in 54 patients (50{\%}), with a median delay of 55 months for the entire cohort. In a univariate analysis, involvement of more than four nodal areas (hazard ratio [HR], 2.26) and serum albumin less than 3.5 g/dL (HR, 3.51) were predictive of a shorter time to lymphoma treatment initiation. In a multivariate analysis, only involvement of more than four nodal areas remained significant (HR, 2.32). The 4-year freedom from treatment failure (FFTF) rate of W&W patients (79{\%}; 95{\%} CI, 69{\%} to 85{\%}) was not inferior to that of a subgroup of 242 patients from the F2-study cohort with good prognosis characteristics who were initially treated with a rituximab-based regimen (69{\%}; 95{\%} CI, 61{\%} to 76{\%}; P = .103). Conclusion: In the rituximab era, patients with FL in a selected prognostically favorable group can still be managed with W&W. W&W does not seem to have detrimental effects on FFTF and overall survival rates after treatment.",
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T1 - Watchful waiting in low-tumor burden follicular lymphoma in the rituximab era

T2 - Results of an F2-study database

AU - Solal-Ceĺigny, Philippe

AU - Bellei, Monica

AU - Marcheselli, Luigi

AU - Pesce, Emanuela Anna

AU - Pileri, Stefano

AU - McLaughlin, Peter

AU - Luminari, Stefano

AU - Pro, Barbara

AU - Montoto, Silvia

AU - Ferreri, Andrés J M

AU - Deconinck, Eric

AU - Milpied, Noël

AU - Gordon, Leo I.

AU - Federico, Massimo

PY - 2012/11/1

Y1 - 2012/11/1

N2 - Purpose: Patients with follicular lymphoma (FL) registered in the F2-study and initially managed without treatment were analyzed to describe the presentation and outcome of a watch and wait (W&W) strategy in the rituximab era, to identify parameters for initiating treatment, and to evaluate whether initial W&W could have deleterious effects on treatment efficacy after progression or relapse. Patients and Methods: Between 2003 and 2005, 120 patients selected from the 1,093 treatment-naive patients with FL in the F2-study cohort were initially managed expectantly (W&W), and 107 patients were assessed. Most of these patients (80%) had disseminated disease with a low tumor burden according to Groupe d'Etudes des Lymphomes Folliculaires criteria. Results: After a median follow-up of 64 months, treatment was initiated in 54 patients (50%), with a median delay of 55 months for the entire cohort. In a univariate analysis, involvement of more than four nodal areas (hazard ratio [HR], 2.26) and serum albumin less than 3.5 g/dL (HR, 3.51) were predictive of a shorter time to lymphoma treatment initiation. In a multivariate analysis, only involvement of more than four nodal areas remained significant (HR, 2.32). The 4-year freedom from treatment failure (FFTF) rate of W&W patients (79%; 95% CI, 69% to 85%) was not inferior to that of a subgroup of 242 patients from the F2-study cohort with good prognosis characteristics who were initially treated with a rituximab-based regimen (69%; 95% CI, 61% to 76%; P = .103). Conclusion: In the rituximab era, patients with FL in a selected prognostically favorable group can still be managed with W&W. W&W does not seem to have detrimental effects on FFTF and overall survival rates after treatment.

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