Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity: Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up

Sandra Lockmer; Bjørn Østenstad; Hans Hagberg; Harald Holte; Ann-Sofie Johansson; Björn Engelbrekt Wahlin; Karin Fahl Wader; Chloé Beate Steen; Peter Meyer; Martin Maisenhølder; Karin Ekström Smedby; Peter Brown; Eva Kimby

doi:10.1200/jco.18.00262

Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity: Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up

Sandra Lockmer, Bjørn Østenstad, Hans Hagberg, Harald Holte, Ann-Sofie Johansson, Björn Engelbrekt Wahlin, Karin Fahl Wader, Chloé Beate Steen, Peter Meyer, Martin Maisenhølder, Karin Ekström Smedby, Peter Brown, Eva Kimby

Department of Clinical Medicine

30 Citations (Scopus)

Abstract

PURPOSE: For indolent lymphoma, the optimal timing, sequence, and choice of therapeutic regimens remain a matter of debate. In two Nordic Lymphoma Group randomized trials, symptomatic or clearly progressing patients were treated first line with a rituximab-containing regimen without chemotherapy. The purpose of this study was to assess long-term survival, risk of transformation, and need of new therapies.

METHODS: Data were 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). All patients received first-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m2, and 148 were randomly allocated to the addition of interferon alfa-2a. Follow-up data were retrieved from initial trial databases and medical records on repeated clinical evaluations.

RESULTS: At the end of follow-up, 73% of patients were alive, with a median follow-up after random assignment of 10.6 years. Among all, 36% (38% with FL) had never needed chemotherapy. For patients with FL who required new therapy within 24 months because of early disease progression, the 10-year survival rate was 59% versus 81% for those with longer remission. Interferon was not shown to improve long-term outcome. Transformation was diagnosed in 20% of all patients (2.4% per person-year) and in 18% with FL. An additional malignancy was found in 12%.

CONCLUSION: Approximately one third of patients with symptomatic indolent lymphoma (30% with FL, 23% without FL) did not need new therapy in the long term after first-line rituximab without chemotherapy. In the entire cohort, 10-year survival was excellent with no major safety issues, which suggests that chemotherapy can be delayed safely in the majority of patients.

Original language	English
Article number	JCO1800262
Journal	Journal of Clinical Oncology
Volume	36
Issue number	33
Pages (from-to)	1-11
ISSN	0732-183X
DOIs	https://doi.org/10.1200/jco.18.00262
Publication status	Published - 20 Nov 2018

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Lockmer, S., Østenstad, B., Hagberg, H., Holte, H., Johansson, A-S., Wahlin, B. E., Wader, K. F., Steen, C. B., Meyer, P., Maisenhølder, M., Smedby, K. E., Brown, P., & Kimby, E. (2018). Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity: Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up. Journal of Clinical Oncology, 36(33), 1-11. [JCO1800262]. https://doi.org/10.1200/jco.18.00262

Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity : Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up. / Lockmer, Sandra; Østenstad, Bjørn; Hagberg, Hans et al.

In: Journal of Clinical Oncology, Vol. 36, No. 33, JCO1800262, 20.11.2018, p. 1-11.

Research output: Contribution to journal › Journal article › Research › peer-review

Lockmer, S, Østenstad, B, Hagberg, H, Holte, H, Johansson, A-S, Wahlin, BE, Wader, KF, Steen, CB, Meyer, P, Maisenhølder, M, Smedby, KE, Brown, P & Kimby, E 2018, 'Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity: Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up', Journal of Clinical Oncology, vol. 36, no. 33, JCO1800262, pp. 1-11. https://doi.org/10.1200/jco.18.00262

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title = "Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity: Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up",

abstract = "PURPOSE: For indolent lymphoma, the optimal timing, sequence, and choice of therapeutic regimens remain a matter of debate. In two Nordic Lymphoma Group randomized trials, symptomatic or clearly progressing patients were treated first line with a rituximab-containing regimen without chemotherapy. The purpose of this study was to assess long-term survival, risk of transformation, and need of new therapies.METHODS: Data were 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). All patients received first-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m2, and 148 were randomly allocated to the addition of interferon alfa-2a. Follow-up data were retrieved from initial trial databases and medical records on repeated clinical evaluations.RESULTS: At the end of follow-up, 73% of patients were alive, with a median follow-up after random assignment of 10.6 years. Among all, 36% (38% with FL) had never needed chemotherapy. For patients with FL who required new therapy within 24 months because of early disease progression, the 10-year survival rate was 59% versus 81% for those with longer remission. Interferon was not shown to improve long-term outcome. Transformation was diagnosed in 20% of all patients (2.4% per person-year) and in 18% with FL. An additional malignancy was found in 12%.CONCLUSION: Approximately one third of patients with symptomatic indolent lymphoma (30% with FL, 23% without FL) did not need new therapy in the long term after first-line rituximab without chemotherapy. In the entire cohort, 10-year survival was excellent with no major safety issues, which suggests that chemotherapy can be delayed safely in the majority of patients.",

author = "Sandra Lockmer and Bj{\o}rn {\O}stenstad and Hans Hagberg and Harald Holte and Ann-Sofie Johansson and Wahlin, {Bj{\"o}rn Engelbrekt} and Wader, {Karin Fahl} and Steen, {Chlo{\'e} Beate} and Peter Meyer and Martin Maisenh{\o}lder and Smedby, {Karin Ekstr{\"o}m} and Peter Brown and Eva Kimby",

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T1 - Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity

T2 - Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up

AU - Lockmer, Sandra

AU - Østenstad, Bjørn

AU - Hagberg, Hans

AU - Holte, Harald

AU - Johansson, Ann-Sofie

AU - Wahlin, Björn Engelbrekt

AU - Wader, Karin Fahl

AU - Steen, Chloé Beate

AU - Meyer, Peter

AU - Maisenhølder, Martin

AU - Smedby, Karin Ekström

AU - Brown, Peter

AU - Kimby, Eva

PY - 2018/11/20

Y1 - 2018/11/20

N2 - PURPOSE: For indolent lymphoma, the optimal timing, sequence, and choice of therapeutic regimens remain a matter of debate. In two Nordic Lymphoma Group randomized trials, symptomatic or clearly progressing patients were treated first line with a rituximab-containing regimen without chemotherapy. The purpose of this study was to assess long-term survival, risk of transformation, and need of new therapies.METHODS: Data were 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). All patients received first-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m2, and 148 were randomly allocated to the addition of interferon alfa-2a. Follow-up data were retrieved from initial trial databases and medical records on repeated clinical evaluations.RESULTS: At the end of follow-up, 73% of patients were alive, with a median follow-up after random assignment of 10.6 years. Among all, 36% (38% with FL) had never needed chemotherapy. For patients with FL who required new therapy within 24 months because of early disease progression, the 10-year survival rate was 59% versus 81% for those with longer remission. Interferon was not shown to improve long-term outcome. Transformation was diagnosed in 20% of all patients (2.4% per person-year) and in 18% with FL. An additional malignancy was found in 12%.CONCLUSION: Approximately one third of patients with symptomatic indolent lymphoma (30% with FL, 23% without FL) did not need new therapy in the long term after first-line rituximab without chemotherapy. In the entire cohort, 10-year survival was excellent with no major safety issues, which suggests that chemotherapy can be delayed safely in the majority of patients.

AB - PURPOSE: For indolent lymphoma, the optimal timing, sequence, and choice of therapeutic regimens remain a matter of debate. In two Nordic Lymphoma Group randomized trials, symptomatic or clearly progressing patients were treated first line with a rituximab-containing regimen without chemotherapy. The purpose of this study was to assess long-term survival, risk of transformation, and need of new therapies.METHODS: Data were 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). All patients received first-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg/m2, and 148 were randomly allocated to the addition of interferon alfa-2a. Follow-up data were retrieved from initial trial databases and medical records on repeated clinical evaluations.RESULTS: At the end of follow-up, 73% of patients were alive, with a median follow-up after random assignment of 10.6 years. Among all, 36% (38% with FL) had never needed chemotherapy. For patients with FL who required new therapy within 24 months because of early disease progression, the 10-year survival rate was 59% versus 81% for those with longer remission. Interferon was not shown to improve long-term outcome. Transformation was diagnosed in 20% of all patients (2.4% per person-year) and in 18% with FL. An additional malignancy was found in 12%.CONCLUSION: Approximately one third of patients with symptomatic indolent lymphoma (30% with FL, 23% without FL) did not need new therapy in the long term after first-line rituximab without chemotherapy. In the entire cohort, 10-year survival was excellent with no major safety issues, which suggests that chemotherapy can be delayed safely in the majority of patients.

U2 - 10.1200/jco.18.00262

DO - 10.1200/jco.18.00262

M3 - Journal article

C2 - 30285560

SN - 0732-183X

VL - 36

SP - 1

EP - 11

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

IS - 33

M1 - JCO1800262

ER -

Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity: Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up

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