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A population‐based study of prognosis in advanced stage follicular lymphoma managed by watch and wait
Author(s) -
ElGalaly Tarec Christoffer,
Bilgrau Anders E.,
Nully Brown Peter,
Mylam Karen J.,
Ahmad Syed A.,
Pedersen Lars M.,
Gang Anne O.,
Bentzen Hans H.,
Juul Maja B.,
Bergmann Olav J.,
Pedersen Robert S.,
Nielsen Berit J.,
Johnsen Hans E.,
Dybkær Karen,
Bøgsted Martin,
Hutchings Martin
Publication year - 2015
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.13316
Subject(s) - medicine , follicular lymphoma , rituximab , asymptomatic , population , lymphoma , stage (stratigraphy) , confidence interval , surgery , oncology , paleontology , environmental health , biology
Summary 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.