Limited stage I and II follicular non-Hodgkin's lymphoma: The Nebraska lymphoma study group experience

Haluk Tezcan, Julie Marie Vose, Martin Bast, Philip Jay Bierman, Anne Kessinger, James Olen Armitage

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

The purpose of this study was to evaluate the outcome and prognostic factors of patients with limited stage follicular non-Hodgkin's lymphoma treated prospectively by the Nebraska Lymphoma Study Group (NLSG). Forty previously untreated patients, median age 64 years, with limited stage follicular lymphoma were prospectively treated according to the protocols of the NLSG between January 1980 and December 1990. The follicular large cell type represents 75% of the cases, and 14 of the biopsies also had a diffuse component (composite lymphoma). The initial treatment was radiation therapy (RT) to the involved field in 15 patients, anthracycline-containing combination chemotherapy (CT) in 20, and combined RT and CT in 5. Thirty-seven patients (92.5%) achieved a complete remission (CR). The median follow-up is 120 months (range, 20 to 214). Of the 37 patients achieving a CR, 7 patients are alive in first CR, one died due to sepsis, another because of a myeloproliferative disorder at 77 months following chemotherapy, 6 died because of unrelated causes in first CR. Twenty-two patients relapsed between 1 to 128 months following a CR. The estimated 10-year event-free survival is 21% (95% Cl:7 to 35). Two patients received no or palliative therapy after relapse and both died of progressive disease. Nineteen patients received salvage therapy and 15 achieved a second remission. The median survival after first relapse is 55 months. The estimated 10-year overall survival is 44% (95% Cl:28 to 60). Various factors including sex, histologic subtype, stage, and degree of follicularity do not influence the overall survival or event-free survival. CT with or without RT resulted in a better trend for 10-year event-free survival in stage IA patients compared to RT alone but estimated 10-year overall survival is no different. The overall survival is worse in the ≥ 60 age group but this difference is not evident if data is adjusted for cause specific death. In conclusion, limited stage follicular lymphoma has an excellent initial response to radiation therapy or chemotherapy; however the recurrence rate is high and cure is limited.

Original languageEnglish (US)
Pages (from-to)273-285
Number of pages13
JournalLeukemia and Lymphoma
Volume34
Issue number3-4
DOIs
StatePublished - Jan 1 1999

Fingerprint

Follicular Lymphoma
Non-Hodgkin's Lymphoma
Lymphoma
Radiotherapy
Survival
Disease-Free Survival
Drug Therapy
Recurrence
Composite Lymphoma
Sex Factors
Salvage Therapy
Myeloproliferative Disorders
Anthracyclines
Combination Drug Therapy
Palliative Care
Cause of Death
Sepsis
Age Groups
Biopsy

Keywords

  • Follicular
  • Limited stage
  • Non-Hodgkins lymphoma
  • Stage I
  • Stage II
  • Treatment

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Limited stage I and II follicular non-Hodgkin's lymphoma : The Nebraska lymphoma study group experience. / Tezcan, Haluk; Vose, Julie Marie; Bast, Martin; Bierman, Philip Jay; Kessinger, Anne; Armitage, James Olen.

In: Leukemia and Lymphoma, Vol. 34, No. 3-4, 01.01.1999, p. 273-285.

Research output: Contribution to journalArticle

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abstract = "The purpose of this study was to evaluate the outcome and prognostic factors of patients with limited stage follicular non-Hodgkin's lymphoma treated prospectively by the Nebraska Lymphoma Study Group (NLSG). Forty previously untreated patients, median age 64 years, with limited stage follicular lymphoma were prospectively treated according to the protocols of the NLSG between January 1980 and December 1990. The follicular large cell type represents 75{\%} of the cases, and 14 of the biopsies also had a diffuse component (composite lymphoma). The initial treatment was radiation therapy (RT) to the involved field in 15 patients, anthracycline-containing combination chemotherapy (CT) in 20, and combined RT and CT in 5. Thirty-seven patients (92.5{\%}) achieved a complete remission (CR). The median follow-up is 120 months (range, 20 to 214). Of the 37 patients achieving a CR, 7 patients are alive in first CR, one died due to sepsis, another because of a myeloproliferative disorder at 77 months following chemotherapy, 6 died because of unrelated causes in first CR. Twenty-two patients relapsed between 1 to 128 months following a CR. The estimated 10-year event-free survival is 21{\%} (95{\%} Cl:7 to 35). Two patients received no or palliative therapy after relapse and both died of progressive disease. Nineteen patients received salvage therapy and 15 achieved a second remission. The median survival after first relapse is 55 months. The estimated 10-year overall survival is 44{\%} (95{\%} Cl:28 to 60). Various factors including sex, histologic subtype, stage, and degree of follicularity do not influence the overall survival or event-free survival. CT with or without RT resulted in a better trend for 10-year event-free survival in stage IA patients compared to RT alone but estimated 10-year overall survival is no different. The overall survival is worse in the ≥ 60 age group but this difference is not evident if data is adjusted for cause specific death. In conclusion, limited stage follicular lymphoma has an excellent initial response to radiation therapy or chemotherapy; however the recurrence rate is high and cure is limited.",
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