Lockmer S, et al. - Researchers assessed long-term survival, risk of transformation, and need of new therapies among symptomatic or clearly progressing patients with indolent lymphoma who were treated first line with a rituximab-containing regimen without chemotherapy in two Nordic Lymphoma Group randomized trials. They observed that, there was 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) who already had received first-line rituximab without chemotherapy. In addition, it was considered safe to delay chemotherapy in the majority of patients because excellent 10-year survival was seen in the entire cohort with no major safety issues.

Methods

• Cross-sectional follow-up were performed to collect data 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).
• First-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m² was received by all patients, and random allocation to the addition of interferon alfa-2a was done in 148.
• Researchers extracted follow-up data from initial trial databases and medical records on repeated clinical evaluations.

Results

• Alive patients at the end of follow-up comprised 73% of the participants, with a median follow-up after random assignment of 10.6 years.
• Chemotherapy was never required for 36% (38% with FL) among all.
• The estimated 10-year survival rate was 59% for patients with FL who required new therapy within 24 months because of early disease progression, compared with 81% for those with longer remission.
• No improvement in long-term outcome was offered by 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.