Clinical management and outcomes of completely resected stage I follicular lymphoma

Abstract

JC EH lin xp ematopathol Original Article INTRODUCTIONFollicular lymphoma (FL) is the second-most common type of non-Hodgkin lymphoma in the United States and Europe, 1,2 and is increasing in frequency even in Japan. 3 FL is characterized by indolent clinical behavior and subsequent histological transformation linked with an aggressive clinical course and poor outcomes. A substantial number of patients exhibit no clinical symptoms and do not need immediate treatment irrespective of clinical stage, although FL is recognized as an incurable malignant disease.The treatment modality for patients with malignant lymphoma is generally selected based on clinical stage being early or advanced. 4 For early-stage FL, involved-field irradiation therapy is recommended by published guidelines. 5,6 Moreover, irradiation is the only treatment strategy to demonstrate any advantage in terms of overall survival, although the evidence for this was obtained from retrospective studies. 7,8 However, the reality is that several treatment strategies have been applied for patients with early-stage FL, including combined-modality therapy (CMT), irradiation alone, watch-and-wait (WW), and more recently, rituximab (R)-containing chemotherapy or R monotherapy, 9-11 probably because recommendations have been based on relatively small, retrospective studies from a single center. Of these, 18 patients underwent total resection after diagnostic tissue biopsy. We used 18 F-fluorodeoxyglucose positron emission CT for staging assessment in 13 of 18 patients (72.2%). The median age was 56.5 years. Six patients (33.3%) were male. The soluble interleukin-2 receptor alpha concentration was significantly lower than in patients with residual disease. Among these 18 patients, 7 patients (38.9%) were treated with a "watch-and-wait" (WW) policy, 7 (38.9%) were treated with involved-field irradiation, and 4 (22.2%) received systemic chemotherapy. Patients with resected disease were treated with significantly different strategies from those with residual disease (p = 0.0026). Five patients experienced relapse during follow-up (median follow-up: 48.2 months). All relapses were distant from the primary site, irrespective of treatment strategy. Among all stage I patients, disease resection was not a significant factor for survival (p = 0.9294). Collectively, the choice of treatment strategy was significantly influenced by patient status. Resection status was not significantly associated with survival after several treatment strategies.