title: Outcomes following watchful waiting for stage II-IV follicular lymphoma patients in the modern era.
abstract: To examine the effectiveness of an initial management strategy of watchful waiting for follicular lymphoma (FL) in clinical practice, we compared outcomes for patients diagnosed 2004-2007 in the United States initially managed with watchful waiting with outcomes following initial rituximab monotherapy and chemoimmunotherapy. In total, 1754 stage II-IV patients in the National LymphoCare Study underwent watchful waiting (n = 386), rituximab monotherapy (n = 296) or rituximab plus chemotherapy (n = 1072) as initial management strategy. Female patients and those who received treatment in the Northeast or in an academic setting more commonly underwent watchful waiting versus initial chemoimmunotherapy; whereas patients with grade 3 histology, anaemia, elevated lactate dehydrogenase, extranodal involvement, B symptoms or performance status ≥1 more commonly received chemoimmunotherapy. Although time to new treatment and progression-free survival following first- and second-line therapy were improved with chemoimmunotherapy, and time to chemotherapy was improved with rituximab monotherapy, there were no differences in overall survival between watchful waiting and chemoimmunotherapy or rituximab monotherapy. With 8-year overall survival estimates of 74%, initial management with watchful waiting in the context of sequential therapy remains a viable option for FL patients in the modern era. This trial was registered at www.clinicaltrials.gov (NCT00097565).
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Loretta J
authors.initials: LJ
authors.lastname: Nastoupil
authors.affiliation: University Oncology & Hematology Associates, Chattanooga, TN, USA.
authors.forename: Rajni
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Genentech/Roche, South San Francisco, CA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Byrtek
authors.affiliation: Biostatistics, RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ziemiecki
authors.affiliation: Biostatistics, RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Xiaolei
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Genentech/Roche, South San Francisco, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Taylor
authors.affiliation: James P. Wilmot Cancer Center, University of Rochester, Rochester, NY, USA.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.affiliation: Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Link
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
authors.affiliation: Genentech/Roche, South San Francisco, CA, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Dawson
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D000069283:Rituximab / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D000069283:Rituximab
keywords: Non-Hodgkin lymphoma; chemotherapy; immunotherapy