Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: a randomised controlled trial

Ardeshna, KM; Smith, Paul J.; Norton, A. J.; Hancock, B. W.; Hoskin, P.; MacLennan, KA; Moon, Re; Jelliffe, A.M.; Hudson, G. Vaughan; Linch, DC

doi:10.1016/s0140-6736(03)14110-4

Cited by 493 publications

(305 citation statements)

References 13 publications

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“…Because of its indolent nature and the fact that traditional treatments do little to improve the OS of patients, studies in FL have shown that an expectant management approach for patients who are clinically asymptomatic results in equivalent OS compared to early initiation of therapy. [9][10][11] While patients who begin treatment when they become symptomatic from their disease usually have responses to therapy, they inevitably relapse and require further salvage regimens. The tendency for remission duration to become shorter with successive therapies has been well documented, 12 and in an attempt to overcome this trend, HDT and ASCT has been investigated for patients with relapsed FL in several studies.…”

Section: Discussionmentioning

confidence: 99%

Effect of prior rituximab on high-dose therapy and autologous stem cell transplantation in follicular lymphoma

Kang

Rybicki

Bolwell

et al. 2007

Bone Marrow Transplant

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Autologous stem-cell transplantation (ASCT) has been used in follicular lymphoma (FL) to achieve durable responses in first remission or in the relapsed or refractory settings. Addition of rituximab to chemotherapy for FL has been shown to improve survival. The impact of prior therapy with rituximab upon the effectiveness of high-dose therapy (HDT) and ASCT in patients with FL is unknown. We retrospectively reviewed consecutive patients with FL who underwent HDT and ASCT. Patients were categorized according to prior therapy with rituximab. Outcomes were compared between groups in all patients and in a well-matched subset. In all 35 patients received prior rituximab and 71 rituximab-naive patients were analyzed. The rituximab-naive group had a median overall survival (OS) that was not reached during follow-up, with a median relapse-free (RFS) survival of 49.9 months. The prior rituximab group also did not reach median OS and had a median RFS of 24.6 months. Survivals were not significantly different in this group or in the well-matched subset. In conclusion, these results suggest that the use of rituximab-based regimens for the treatment of FL does not compromise the effectiveness of HDT and ASCT as a salvage strategy in patients with FL.

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Section: Discussionmentioning

confidence: 99%

Effect of prior rituximab on high-dose therapy and autologous stem cell transplantation in follicular lymphoma

Kang

Rybicki

Bolwell

et al. 2007

Bone Marrow Transplant

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“…Additional chemoimmunotherapy only improves progression‐free survival instead of overall survival for the patients with early‐stage FL 3. On the contrast, patients with asymptomatic advanced‐stage FL do not need to be treated immediately 1, 5, 6, 7. Once they develop symptoms, chemotherapies with rituximab are suggested as frontline treatments 1, 4, 8, 9, 10, 11…”

Section: Introductionmentioning

confidence: 99%

Rituximab maintenance improves overall survival in follicular lymphoma: A retrospective nationwide real‐world analysis from Taiwan Cancer Registry Database

et al. 2018

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Follicular lymphoma (FL) is the most frequent indolent lymphoma in Western countries, but it is less frequent in Asia. Several trials have demonstrated the progression‐free benefit of rituximab maintenance for FL patients in Western countries. However, the overall survival (OS) benefits and effectiveness of rituximab maintenance in Asian FL patients remain uncertain. We utilized the Taiwan Cancer Registry Database and the National Health Insurance Research Database to investigate the roles of rituximab maintenance for newly diagnosed FL patients in Taiwan. Among 836 patients with newly diagnosed FL during 2009‐2012, we enrolled patients with stage II‐IV diseases receiving 4‐8 cycles of rituximab‐containing induction chemotherapies (R‐induction). We excluded those who died or received additional chemotherapy within 180 days after R‐induction. Among the 396 enrolled patients, 260 underwent rituximab maintenance (R‐maintenance group), and 136 served as the observation group. The R‐maintenance group received less anthracycline and fewer cycles of R‐induction than the observation group, but they exhibited a significantly better OS both in the univariate and multivariate analyses [hazard ratio, 0.42; 95% confidence interval, 0.19‐0.91] after adjusting for age, sex, and Ann Arbor stages. Meanwhile, we also found more patients required further therapies in the first 6 months after the cease of rituximab maintenance. In the subgroup analysis, patients older than 60 years or with stage IV diseases benefited more from rituximab maintenance. Conclusively, our nationwide study is the first one to demonstrate the OS benefit of rituximab maintenance after induction therapies in newly diagnosed FL patients from Asian populations.

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“…The WW strategy can also be pursued with good results in some ocular, adnexal, and pulmonary MALT lymphomas [9,10]. The LL patients may be treated with several approaches, including WW in those who are asymptomatic with low tumour burden [11]. In patients with SLL, a WW strategy is indicated as an initial approach, with treatment considered only for patients with disease-related symptoms or progressive or advanced stage disease [12].…”

Section: Introductionmentioning

confidence: 99%

Whole body magnetic resonance in indolent lymphomas under watchful waiting: The time is now

et al. 2017

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The indolent non-Hodgkin lymphomas (i-NHLs) are characterised by 'indolent' clinical behaviour with slow growth and prolonged natural history. The watchful waiting (WW) strategy is a frequently employed treatment option in these patients. This implies a strict monitoring by imaging examinations, including 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) and CT. A major concern is radiation exposure due to regularly monitoring by conventional imaging procedures. Several studies have demonstrated the reliability of whole-body magnetic resonance imaging (WB-MRI) for lymphoma staging. WB-MRI could be useful for active surveillance in iNHLs providing the suspect of disease progression that can be then confirmed by additional diagnostic procedures, including 18F-FDG-PET/CT. The directive 2013/59 by the European Union claims that if a radiation-free imaging technique allows obtaining the same diagnostic results, it should be invariably used.In this setting, WB-MRI may be considered a reasonable option in i-NHLs under WW, replacing imaging modalities that cause exposure to ionising radiations. This will help to reduce the cancer risk in i-NHL patients for whom chemo-/radiotherapy remain the usual treatment options following the usually long WW phase. The scientific community should raise the awareness of the risk of ionising radiations in i-NHLs and the emphasise the need for establishing the proper place of WB-MRI in lymphoma imaging. Key Points• Watchful waiting is a reasonable option in patients with indolent non-Hodgkin lymphomas.• Imaging is crucial to monitor patients with indolent nonHodgkin lymphomas.• CT and 18 F-FDG-PET/CT are commonly used, implying a substantial radiation exposure.• WB-MRI is highly reliable in lymphoma staging.• WB-MRI may be considered to monitor indolent nonHodgkin lymphomas under watchful waiting.

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Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: a randomised controlled trial

Cited by 493 publications

References 13 publications

Effect of prior rituximab on high-dose therapy and autologous stem cell transplantation in follicular lymphoma

Effect of prior rituximab on high-dose therapy and autologous stem cell transplantation in follicular lymphoma

Rituximab maintenance improves overall survival in follicular lymphoma: A retrospective nationwide real‐world analysis from Taiwan Cancer Registry Database

Whole body magnetic resonance in indolent lymphomas under watchful waiting: The time is now

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