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Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma

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Key Points

  • Initial treatment with rituximab and no chemotherapy was associated with high 10-year survival among all patients and those with follicular lymphoma.
  • Overall, 36% of all patients and 38% of those with follicular lymphoma never required chemotherapy.

In an analysis of two Nordic Lymphoma Group trials with long-term follow up reported in the Journal of Clinical Oncology, Lockmer and colleagues found evidence that many patients receiving rituximab (Rituxan) as initial treatment for advanced indolent lymphoma may not require the addition of chemotherapy.   

The study involved analysis of data from 321 patients with indolent lymphoma, including 84% with follicular lymphomas, treated in two Nordic Lymphoma Group trials (accrual 1998–1999 and 2002–2008). All patients received first-line therapy with 1 or 2 cycles of 4 weekly infusions of rituximab at 375 mg/m2; 148 were randomized to the addition of interferon alfa-2a.

Survival Outcomes

After a median follow-up of 10.6 years, 73% of all patients remained alive, with 10-year overall survival and lymphoma-specific survival of 75% and 81%; 73% of those with follicular lymphoma remained alive, with 10-year overall and lymphoma-specific survival of 75% and 82%. In total, 36% of all patients and 38% of those with follicular lymphoma never required chemotherapy.

Ten-year survival rates were 59% among patients with follicular lymphoma who required new therapy within 24 months due to early progression vs 81% among patients with longer remission durations. Interferon treatment was not associated with improved long-term outcome. Transformation to aggressive lymphoma was observed in 20% of all patients, a rate of 2.4% per person-year, and in 18% of those with follicular lymphoma. Overall, additional malignancies were found in 12% of patients.

The investigators concluded, “Approximately one-third of patients with symptomatic indolent lymphoma (30% with [follicular lymphoma], 23% without [follicular lymphoma]) did not need new therapy in the long term after first-line rituximab without chemotherapy. In the entire cohort, 10-year survival was excellent with no major safety issues, which suggests that chemotherapy can be delayed safely in the majority of patients.”

The work was supported in part by governmental research funds from the Stockholm County Council and by the Nordic Lymphoma Group. The initial (investigator-initiated) randomized trials were supported by Roche.

Sandra Lockmer, MD, of the Karolinska Universitetssjukhuset Solna, Stockholm, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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