title: A population-based study of prognosis in advanced stage follicular lymphoma managed by watch and wait.
abstract: Watch and wait (WAW) is a common approach for asymptomatic, advanced stage follicular lymphoma (FL), but single-agent rituximab is an alternative for these patients. In this nationwide study we describe the outcome of patients selected for WAW. A cohort of 286 out of 849 (34%) stage III-IVA FL patients seen between 2000 and 2011, were managed expectantly and included. The 5-year progression-free survival (PFS) was 35% [95% confidence interval (CI) 29-42]. The 10-year overall survival (OS) was 65% (95%CI 54-78), and the cumulative risk of dying from lymphoma within 10 years of diagnosis was 13% (95%CI 7-20). Elevated lactate dehydrogenase and > four nodal regions involved were associated with a higher risk of lymphoma treatment and death from lymphoma. The WAW patients and a matched background population had similar OS during the first 50 months after diagnosis (P = 0·7), but WAW patients had increased risk of death after 50 months (P < 0·001). The estimated loss of residual life after 10 years was 6·8 months. The 10-year cumulative risk of histological transformation was 22% (95%CI 15-29) and the 3-year OS after transformation was 71% (95%CI 58-87%). In conclusion, advanced stage FL managed by WAW had a favourable outcome and abandoning this strategy could lead to overtreatment in some patients.
authors.affiliation: Department of Haematology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Tarec Christoffer
authors.initials: TC
authors.lastname: El-Galaly
authors.forename: Anders E
authors.initials: AE
authors.lastname: Bilgrau
authors.forename: Peter
authors.initials: P
authors.lastname: de Nully Brown
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Mylam
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Lars M
authors.initials: LM
authors.lastname: Pedersen
authors.forename: Anne O
authors.initials: AO
authors.lastname: Gang
authors.forename: Hans H
authors.initials: HH
authors.lastname: Bentzen
authors.forename: Maja B
authors.initials: MB
authors.lastname: Juul
authors.forename: Olav J
authors.initials: OJ
authors.lastname: Bergmann
authors.forename: Robert S
authors.initials: RS
authors.lastname: Pedersen
authors.forename: Berit J
authors.initials: BJ
authors.lastname: Nielsen
authors.forename: Hans E
authors.initials: HE
authors.lastname: Johnsen
authors.forename: Karen
authors.initials: K
authors.lastname: Dybkaer
authors.forename: Martin
authors.initials: M
authors.lastname: Bøgsted
authors.forename: Martin
authors.initials: M
authors.lastname: Hutchings
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D011379:Prognosis; D012189:Retrospective Studies; D057832:Watchful Waiting
keywords: follicular lymphoma; histological transformation; overall survival; progression-free survival; watch and wait