Lockmer S, et al. - Researchers evaluated long-term survival, risk of transformation, and need of new therapies in 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. They found that, no new therapy was required in the long term in nearly one third of patients with symptomatic indolent lymphoma (30% with follicular lymphomas [FL], 23% without FL) treated with first-line rituximab without chemotherapy. In the entire cohort, no major safety issues were seen and an excellent 10-year survival was reported. These findings are suggestive of the safety of delaying chemotherapy in the majority of patients.

Methods

• Participants were 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).
• Data were collected for these patients during cross-sectional follow-up.
• First-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m² was used to treat all patients, and 148 were randomly allocated to the addition of interferon alfa-2a.
• Using initial trial databases and medical records on repeated clinical evaluations, follow-up data were retrieved.

Results

• After random assignment, a median follow-up of 10.6 years was performed, at the end of which, 73% of patients were found alive.
• Chemotherapy was never needed in 36% (38% with FL) of all.
• The observed 10-year survival rate was 59% vs 81% for patients with FL who required new therapy within 24 months because of early disease progression vs those with longer remission, respectively.
• 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 were found to have an additional malignancy.