title: The role of "watch and wait" in intestinal follicular lymphoma in rituximab era.
abstract: OBJECTIVE
  There is no consensus regarding the best treatment for intestinal follicular lymphoma (FL). We used "watch and wait" for patients with intestinal FL with low-tumor-burden (LTB) criteria and without mass formation causing bowel obstruction. We investigated the overall survival (OS) and time to treatment required (TTR).
  
  
  METHODS
  Thirty-three intestinal FL patients [clinical stage (CS) I:16, II1:0, II2:7, IV:10; median observation period: 45.5 months, range: 13-110 months] were diagnosed via endoscopy. Detailed clinical and pathological examinations were performed, and neoplastic process behavior was monitored.
  
  
  RESULTS
  All of the 33 patients were WHO grade 1. FL lesions in the digestive tract were found frequently in the second-fourth portion of the duodenum in 91% of the patients; 87% of those patients had lesions in a broader area including the small intestine. Two patients had an enlargement of the area of the lesions and a worsening of the macroscopic findings. Three patients had CS progression; however, these remained within the indication for "watch and wait." Two patients with transformation into diffuse large B-cell lymphoma received rituximab and chemotherapy, which led to complete remission. The OS was 100%. The time to treatment required (TTR) was 49 months in one patient and 37 months in one patient.
  
  
  CONCLUSIONS
  Intestinal FL in CS I-IV with broad infiltration of the digestive tract meeting the criteria for LTB had a remarkably slow course. This study suggests that "watch and wait" is appropriate for the treatment of LTB intestinal FL even in the era of rituximab.
authors.affiliation: a Department of Internal Medicine and.
authors.forename: Akira
authors.initials: A
authors.lastname: Tari
authors.affiliation: b Department of Clinical Laboratory , Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital , Hiroshima , Japan .
authors.forename: Hideki
authors.initials: H
authors.lastname: Asaoku
authors.affiliation: c Department of Pathology , Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences , Okayama , Japan .
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Takata
authors.affiliation: d Department of Gastroenterology , Chiba Hokusou Hospital, Nippon Medical School , Chiba , Japan .
authors.forename: Shunji
authors.initials: S
authors.lastname: Fujimori
authors.affiliation: e Department of Endoscopy , Hiroshima University Hospital , Hiroshima , Japan .
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: f Department of Pathology , Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital , Hiroshima , Japan , and.
authors.forename: Megumu
authors.initials: M
authors.lastname: Fujihara
authors.affiliation: g CPC Clinical Trial Hospital , Kagoshima , Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Koga
authors.affiliation: c Department of Pathology , Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences , Okayama , Japan .
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yoshino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004379:Duodenal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000069283:Rituximab / Q000627:therapeutic use*; D015996:Survival Rate; D057832:Watchful Waiting
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: histologic transformation; intestinal follicular lymphoma; low-tumor-burden; treatment; watch and wait