scholarly journals Is watch and wait still acceptable for patients with low-grade follicular lymphoma?

Blood ◽  
2016 ◽  
Vol 127 (23) ◽  
pp. 2804-2808 ◽  
Author(s):  
James O. Armitage ◽  
Dan L. Longo
Keyword(s):  
Follicular Lymphoma ◽  
The United States ◽  
Initial Therapy ◽  
Treatment Recommendation ◽  
Low Grade ◽  
Watch And Wait ◽  
New Agents ◽  
Initial Report ◽  
Asymptomatic Patients ◽  
Disseminated Disease

Abstract Follicular lymphoma (FL) represents more than 20% of all non-Hodgkin lymphomas worldwide and approximately 30% of the non-Hodgkin lymphomas diagnosed in the United States. Although occasionally localized at the time of diagnosis, most patients have disseminated disease. However, patients are frequently asymptomatic, and this, in combination with a long median survival, led to the initial studies of observing asymptomatic patients without initial therapy, ie, “watch and wait.” Since the initial report of watch and wait as a treatment strategy for patients with low-grade FL, our understanding of the biology of the disease has advanced; multiple active new agents have been introduced into practice, and the survival of patients with low-grade FL has improved. Given these changes, is watch and wait still an acceptable treatment recommendation for a newly diagnosed patient with low-grade FL?

Primary Follicular Lymphoma of the Duodenum Is a Distinct Mucosal/Submucosal Variant of Follicular Lymphoma: A Retrospective Study of 63 Cases

2011 ◽  
Vol 29 (11) ◽  
pp. 1445-1451 ◽  
Author(s):  
Ana-Iris Schmatz ◽  
Berthold Streubel ◽  
Elisabeth Kretschmer-Chott ◽  
Andreas Püspök ◽  
Ulrich Jäger ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Stable Disease ◽  
Cell Transformation ◽  
Large Cell ◽  
Low Grade ◽  
Complete Regression ◽  
Watch And Wait ◽  
Small Series ◽  
Anti Cd20

Purpose Small series with limited follow-up have suggested primary follicular lymphoma of the duodenum (FL-D) to be an indolent disease. We report our experience on a large series of patients followed for a median time period of longer than 6 years. Patients and Methods The study comprised 63 patients with primary FL-D defined as stage I disease. Endoscopy and detailed pathologic work-up was performed at diagnosis and at restaging to monitor the behavior of the neoplastic process. Results Histologically, all 63 patients had FL, low grade (1 to 2). Duodenal endosonography demonstrated lesions confined to mucosa/submucosa in 19 of 20 patients. At an overall median follow-up of 77 months (range, 12 to 177 months), only two untreated patients had developed nodal disease, the remaining 61 patients never experienced extrasmall intestinal disease and large cell transformation did not occur at all. Among 24 patients followed by watch and wait strategy, seven showed spontaneous complete regression and 17 had stable disease; radiotherapy resulted in complete regression in all 19 patients; anti-CD20 antibody monotherapy achieved complete regression in four patients and stable disease in one patient. Various chemotherapy protocols in eight patients caused complete regression in all of them, but local relapses occurred in three. No patients required surgery or died of disease. Conclusion These findings characterize primary FL-D as a remarkably indolent FL variant, which, even left untreated, does not develop tumorous growth, very rarely disseminates (two of 63 patients) and does not transform to high grade disease. A watch and wait approach appears to be the most sensible strategy.

Advanced Stage Follicular Lymphoma - Watch and Wait or Immunochemotherapy?

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5476-5476
Author(s):  
Dulcineia Pereira ◽  
Carolina Teixeira ◽  
Sofia Ramalheira ◽  
Patricia Rocha ◽  
Claudia Moreira ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Tumor Burden ◽  
Small Sample ◽  
Stage Iii ◽  
Advanced Stage ◽  
Line Treatment ◽  
Watch And Wait ◽  
High Tumor Burden ◽  
Asymptomatic Patients ◽  
The Impact

Abstract BACKGROUND: The outcome of patients with advanced stage Follicular Lymphoma (FL) has improved over the last decade, with the use of monoclonal antibodies (mAbs). The watch and wait approach (WW) in FL with low tumor burden was assumed when treatment options were limited and less effective than nowadays. In FL patients with indolent disease characterized by multiple relapses evolution, the therapeutic strategy should take into consideration the quality and duration of response and the impact on overall survival (OS) versus the risk of long-term toxicity. AIMS: Evaluation of the impact of WW approach compared with chemotherapy (CT) in time to next treatment (TNT), progression-free survival (PFS) and OS. METHODS: Retrospective study of 213 patients with FL, followed in a cancer care center between 2000-2012. Of these, 79 asymptomatic patients at diagnosis, with Ann Arbor stage III-IV were included and divided in 2 subgroups: 58 patients received the first-line treatment and 21 remained in surveillance. Tumor burden defined according to criteria of the Groupe d'Etude des Lymphomes Folliculaires (GELF). Survival analysis using the Kaplan-Meier method. Type of response defined according to NCCN criteria. RESULTS: Median follow-up of 48 months (12-147). 41 of the 58 patients submitted to 1st line treatment [median age 57 years (38-72), 36.2% male], underwent CT regimen containing Rituximab. The majority of these patients presented with follicular pattern and histological grade 1/2 (89.7%), 34.5% had FLIPI ≥ 3 and 50 % high tumor burden (GELF), 15.5% bulky mass, 53.4% had > 4 nodal areas involved and 6.9% > 1 extranodal area involved. 52 of the treated patients (89.7%) achieved CR and in 4 progression occurred (6.9%). 50 patients (86.2%) were alive without evidence of disease at the end of study (86.2%). In the group of patients undergoing surveillance, 11 suffered disease progression (52.4%), of which 10 (47.6%) stayed alive without evidence of disease. The TNT was higher in patients undergoing 1st CT regimen, compared to patients on WW (median 1480.5 vs. 765 months, p <0.001) with significant impact on PFS (p <0.001) but not on OS. Analyzing the treated subgroup, the addition of immunotherapy resulted in better TNT and PFS compared to WW (p <0.001), without affecting the OS. In univariate Cox regression analysis, the number of areas and extranodal tumor burden (GELF) were independent predictors of PFS and TNT (p <0.05). CONCLUSION: In asymptomatic patients with FL stage III-IV and high tumor burden, the CT especially when combined with immunotherapy, showed significant improvement on TNT and PFS compared to a WW approach, with no impact on OS. Despite a small sample group with retrospective data, our results are in agreement with the published literature. Disclosures No relevant conflicts of interest to declare.

scholarly journals Follicular Lymphoma in the United States: First Report of the National LymphoCare Study

2009 ◽  
Vol 27 (8) ◽  
pp. 1202-1208 ◽  
Author(s):  
Jonathan W. Friedberg ◽  
Michael D. Taylor ◽  
James R. Cerhan ◽  
Christopher R. Flowers ◽  
Hildy Dillon ◽  
...  
Keyword(s):  
United States ◽  
Radiation Therapy ◽  
Follicular Lymphoma ◽  
De Novo ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
The United States ◽  
Initial Therapy ◽  
Small Subset ◽  
Initial Care

PurposeOptimal 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 MethodsThe 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.ResultsTwo 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.ConclusionWidely 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.

Real-world treatment patterns and outcomes in patients with follicular lymphoma in the United States.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19534-e19534
Author(s):  
Jamie T. Ta ◽  
Taha Itani ◽  
Sheila Shapouri ◽  
Stella Arndorfer ◽  
Cristina Julian ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Clinical Outcomes ◽  
Real World ◽  
The United States ◽  
Aggressive Lymphoma ◽  
Trial Participation ◽  
Low Grade ◽  
Cell Transplant ◽  
The Us

e19534 Background: Despite the availability of new therapies for follicular lymphoma (FL), there are limited data on the real-world treatment (tx) of FL in a contemporary cohort of patients (pts). We examined tx patterns and outcomes in pts who received FL therapy in the US. Methods: This retrospective cohort study used the nationwide Flatiron Health electronic health record-derived de-identified database. During the study, the de-identified data originated from ̃280 cancer clinics (̃800 sites of care) in the US. We selected pts aged ≥18 years, with an initial FL diagnosis (ICD-9-CM: 202.0x; ICD-10-CM: C82.0x) between January 2011 and July 2020, who had received ≥1 line of therapy (LOT) for FL (follow-up ended September 2020). The initiation date of a LOT was considered the index date for analyses by LOT. Pts with evidence of clinical trial participation during the study period, high-grade (3b) FL at diagnosis, transformed aggressive lymphoma at any time before first-line (1L) FL tx, or chemotherapy/immunotherapy or stem cell transplant 12 months before 1L FL tx, were excluded. Pt characteristics at diagnosis were assessed using descriptive statistics. Tx patterns and clinical outcomes (time to next tx [TTNT] and overall survival [OS]) were reported by LOT. Median TTNT and OS were estimated using Kaplan–Meier methods. Results: Overall, 2383 pts met all eligibility criteria. Median age at FL diagnosis was 66 years; 49.2% were male, 77.5% had low-grade (1–2) FL, and 75.2% had advanced stage (III/IV) FL at diagnosis. Median follow-up was 43.1 months, and median time from diagnosis to 1L FL tx was 38 days. Most pts received up to 2 LOTs (n=2258 [94.8%]). The most common regimens across all LOTs were rituximab-bendamustine (R-benda; n=1256 [52.7%]), R monotherapy (n=812 [34.1%]), R-CHOP (n=483 [20.3%]), R-CVP (n=172 [7.2%]), and obinutuzumab (G)-benda (n=77 [3.2%]). The use of newer FL therapies was limited across all LOTs, but more common in the third-line onwards (3L+): chemotherapy-free combinations (R-/G-lenalidomide): 2.3% (all LOTs) and 19.2% (3L+); and phosphoinositide 3-kinase inhibitors: 1.6% (all LOTs) and 21.6% (3L+). In total, 111 (4.7%) pts received G-based regimens. Median TTNT after 1L and second-line onwards (2L+) was 79.4 months and 38.3 months, respectively. Median OS was not reached (NR) and 82.9 months after 1L and 2L+, respectively (Table). Conclusions: We provide a comprehensive update on real-world tx patterns and clinical outcomes in pts with FL in the US. Chemoimmunotherapy remains the standard of care across all LOTs, though the shorter durations of TTNT and OS in 2L+ may support the role of novel therapies in this setting. Tx outcomes by LOT.[Table: see text]

scholarly journals The Cardiometabolic Health Benefits of Sauna Exposure in Individuals with High-Stress Occupations. A Mechanistic Review

2021 ◽  
Vol 18 (3) ◽  
pp. 1105
Author(s):  
Kaemmer N. Henderson ◽  
Lauren G. Killen ◽  
Eric K. O’Neal ◽  
Hunter S. Waldman
Keyword(s):  
Multiple Stressors ◽  
Heat Exposure ◽  
High Stress ◽  
The United States ◽  
Cellular Level ◽  
Cardiometabolic Health ◽  
Low Grade ◽  
Current Standard ◽  
The Metabolic Syndrome ◽  
Sauna Bathing

Components of the metabolic syndrome (i.e., hypertension, insulin resistance, obesity, atherosclerosis) are a leading cause of death in the United States and result in low-grade chronic inflammation, excessive oxidative stress, and the eventual development of cardiometabolic diseases (CMD). High-stress occupations (HSO: firefighters, police, military personnel, first responders, etc.) increase the risk of developing CMD because they expose individuals to chronic and multiple stressors (i.e., sleep deprivation, poor nutrition habits, lack of physical activity, psychological stress). Interestingly, heat exposure and, more specifically, sauna bathing have been shown to improve multiple markers of CMD, potentially acting as hormetic stressors, at the cellular level and in the whole organism. Therefore, sauna bathing might be a practical and alternative intervention for disease prevention for individuals with HSO. The purpose of this review is to detail the mechanisms and pathways involved in the response to both acute and chronic sauna bathing and collectively present sauna bathing as a potential treatment, in addition to current standard of care, for mitigating CMD to both clinicians and individuals serving in HSO.

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