title: Follicular lymphoma in the United States: first report of the national LymphoCare study.
abstract: OBJECTIVE
  Optimal therapy of follicular lymphoma (FL) is not defined. We analyzed a large prospective cohort study to identify current demographics and patterns of care of FL in the United States.
  
  
  METHODS
  The National LymphoCare Study is a multicenter, longitudinal, observational study designed to collect information on treatment regimens and outcomes for patients with newly diagnosed FL in the United States. Patients were enrolled between 2004 and 2007. There is no study-specific prescribed treatment regimen or intervention.
  
  
  RESULTS
  Two thousand seven hundred twenty-eight subjects were enrolled at 265 sites, including the 80% of patients enrolled from nonacademic sites. Using the Follicular Lymphoma International Prognostic Index (FLIPI), three distinct groups independent of histologic grade could be defined. Initial therapeutic strategy was: observation, 17.7%; rituximab monotherapy, 13.9%; clinical trial 6.1%; radiation therapy, 5.6%; chemotherapy only, 3.2%; chemotherapy plus rituximab, 51.9%. Chemotherapy plus rituximab regimens were: rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone, 55.0%; rituximab plus cyclophosphamide, vincristine, and prednisone, 23.1%; rituximab plus fludarabine based, 15.5%; other, 6.4%. The choice to initiate therapy rather than observe was associated with age, FLIPI, stage, and grade (P < .01). Significant differences in treatment (P < .01) across regions of the United States were noted. Contrary to practice guidelines, treatment of stage I FL frequently omits radiation therapy.
  
  
  CONCLUSIONS
  Widely disparate therapeutic approaches are utilized for FL. Initial therapy is deferred in a small subset of patients. There is no single standard of care for the treatment of de novo FL, although antibody use is ubiquitous when therapy is initiated. These disparate approaches to the initial care of patients with FL render a heterogeneous group of patients at relapse.
authors.affiliation: Wilmot Cancer Center, University of Rochester, Rochester, NY, USA.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.forename: Michael D
authors.initials: MD
authors.lastname: Taylor
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.forename: Hildy
authors.initials: H
authors.lastname: Dillon
authors.forename: Charles M
authors.initials: CM
authors.lastname: Farber
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rogers
authors.forename: John D
authors.initials: JD
authors.lastname: Hainsworth
authors.forename: Elaine K
authors.initials: EK
authors.lastname: Wong
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: Brian K
authors.initials: BK
authors.lastname: Link
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018426:SEER Program