Follicular Lymphoma in the United States: First Report of the National LymphoCare Study
- 10 March 2009
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 27 (8), 1202-1208
- https://doi.org/10.1200/jco.2008.18.1495
Abstract
Purpose: Optimal therapy of follicular lymphoma (FL) is not defined. We analyzed a large prospective cohort study to identify current demographics and patterns of care of FL in the United States. Patients and Methods: The National LymphoCare Study is a multicenter, longitudinal, observational study designed to collect information on treatment regimens and outcomes for patients with newly diagnosed FL in the United States. Patients were enrolled between 2004 and 2007. There is no study-specific prescribed treatment regimen or intervention. Results: Two thousand seven hundred twenty-eight subjects were enrolled at 265 sites, including the 80% of patients enrolled from nonacademic sites. Using the Follicular Lymphoma International Prognostic Index (FLIPI), three distinct groups independent of histologic grade could be defined. Initial therapeutic strategy was: observation, 17.7%; rituximab monotherapy, 13.9%; clinical trial 6.1%; radiation therapy, 5.6%; chemotherapy only, 3.2%; chemotherapy plus rituximab, 51.9%. Chemotherapy plus rituximab regimens were: rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone, 55.0%; rituximab plus cyclophosphamide, vincristine, and prednisone, 23.1%; rituximab plus fludarabine based, 15.5%; other, 6.4%. The choice to initiate therapy rather than observe was associated with age, FLIPI, stage, and grade (P < .01). Significant differences in treatment (P < .01) across regions of the United States were noted. Contrary to practice guidelines, treatment of stage I FL frequently omits radiation therapy. Conclusion: Widely disparate therapeutic approaches are utilized for FL. Initial therapy is deferred in a small subset of patients. There is no single standard of care for the treatment of de novo FL, although antibody use is ubiquitous when therapy is initiated. These disparate approaches to the initial care of patients with FL render a heterogeneous group of patients at relapse.Keywords
This publication has 39 references indexed in Scilit:
- Risk and Clinical Implications of Transformation of Follicular Lymphoma to Diffuse Large B-Cell LymphomaJournal of Clinical Oncology, 2007
- Cancer Statistics, 2007CA: A Cancer Journal for Clinicians, 2007
- Is the follicular lymphoma international prognostic index better than the international prognostic index to identify high-risk follicular lymphoma patients?Leukemia & Lymphoma, 2007
- New Treatment Options Have Changed the Survival of Patients With Follicular LymphomaJournal of Clinical Oncology, 2005
- Follicular lymphoma in early stages: high risk of relapse and usefulness of the Follicular Lymphoma International Prognostic Index to predict the outcome of patientsEuropean Journal of Haematology, 2005
- Improved Survival of Follicular Lymphoma Patients in the United StatesJournal of Clinical Oncology, 2005
- Minimum Clinical Recommendations for diagnosis, treatment and follow-up of newly diagnosed follicular lymphomaAnnals of Oncology, 2005
- Barriers to Clinical Trial Enrollment: Are State Mandates the Solution?JNCI Journal of the National Cancer Institute, 2004
- Long term assessment of patterns of treatment failure and survival in patients with stage I or II follicular lymphomaCancer, 1995
- The Natural History of Initially Untreated Low-Grade Non-Hodgkin's LymphomasThe New England Journal of Medicine, 1984