Lockmer S, et al. - Researchers assessed long-term survival, risk of transformation, and need of new therapies for symptomatic or clearly progressing patients who were treated first line with a rituximab-containing regimen without chemotherapy for indolent lymphoma in two Nordic Lymphoma Group randomized trials. According to findings, treatment with first-line rituximab without chemotherapy resulted in no need of new therapy in the long term in nearly one third of patients with symptomatic indolent lymphoma (30% with follicular lymphomas [FL], 23% without FL). Chemotherapy can be delayed safely in the majority of patients, as excellent 10-year survival was reported in the entire cohort with no major safety issues.

Methods

• Researchers analyzed data collected at cross-sectional follow-up for 321 patients with indolent lymphoma (84% with follicular lymphomas [FL]) included in one of two Nordic Lymphoma Group trials (accrual 1998 to 1999 and 2002 to 2008).
• They administered first-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m²in all patients, and 148 were randomly allocated to the addition of interferon alfa-2a.
• They extracted follow-up data from initial trial databases and medical records on repeated clinical evaluations.

Results

• After random assignment, a median follow-up of 10.6 years was performed; 73% of patients were alive at the end of follow-up.
• Among all, chemotherapy was never required for 36% (38% with FL).
• The observed 10-year survival rate was 59% for patients with FL who required new therapy within 24 months because of early disease progression vs 81% for those with longer remission.
• No improvement in long-term outcome was seen with interferon.
• In 20% of all patients (2.4% per person-year) and in 18% with FL, transformation was diagnosed.
• Twelve percent had an additional malignancy.