TREATMENT AND PROGNOSIS OF STAGE I FOLLICULAR LYMPHOMA IN THE MODERN ERA - DOES PET-CT MATTER?
(Abstract release date: 05/19/16)
EHA Library. Bentur O. 06/09/16; 132702; E1153
Dr. Ohad Bentur
Contributions
Contributions
Abstract
Abstract: E1153
Type: Eposter Presentation
Background
Follicular lymphoma (FL) is the most common indolent non-Hodgkin Lymphoma. Treatment of stage I disease is usually radiation monotherapy, but debate over the role of additional chemo-immunotherapy exists. Most of the data on treatment and prognosis are based on retrospective historical cohorts before PET-CT was introduced into routine staging procedures. In these previous cohorts, 5 year freedom from treatment failure (FFTF) was 60-80% and the 5 year overall survival (OS) was 80-93%.
Aims
The current study assessed the outcome of patients diagnosed with stage I FL who were treated with radiotherapy with or without rituximab, in the PET-CT era.
Methods
Patients diagnosed with stage I FL based on PET-CT and bone marrow biopsy (BMB), who were treated with involved field radiotherapy between 2002-2015, were retrospectively reviewed in this multi-center study. Patients were treated with either radiation monotherapy or radiotherapy and rituximab.
Results
Ninety one patients from 9 centers were identified. The median age at diagnosis was 60 years (range: 31-93) years. FLIPI score was compatible with a low risk disease (0 or 1) in 93% and with an intermediate risk (FLIPI =2) in 7% of the patients. Forty eight percent of the patients had FL Grade 1, 39%>Grade 2 and 13% -Grade 3a FL, with 30% presenting with an extra-nodal disease. Median radiation dose was 30.2 (18-50) Gy. Most patients were treated with radiation monotherapy (71 patients, 78%), additional rituximab was administered to 20 patients (22%). Within a median follow-up of 57 months, the 5 year FFTF and OS survival rates were 76% and 97% respectively (Figure 1). Twenty one percent of the patients (n=19) experienced relapse; most relapses (n=14) were outside the radiation field. An intermediate risk FLIPI score was the only independent significant factor for a shorter FFTF [HR=2.3, 95% CI= 1.096 - 4.89, p=0.028].Radiation dose or adjuvant rituximab therapy did not significantly affect outcome.
Conclusion
Our findings show that staging with PET-CT and BMB of stage I FL may result in improved FFTF and OS in patients treated with radiotherapy compared to historical cohorts, possibly due to better identification of a true stage I disease. The distant nature of recurrences suggests that occult distant disease foci, not diagnosed even by PET-CT, are still possible.
Session topic: E-poster
Type: Eposter Presentation
Background
Follicular lymphoma (FL) is the most common indolent non-Hodgkin Lymphoma. Treatment of stage I disease is usually radiation monotherapy, but debate over the role of additional chemo-immunotherapy exists. Most of the data on treatment and prognosis are based on retrospective historical cohorts before PET-CT was introduced into routine staging procedures. In these previous cohorts, 5 year freedom from treatment failure (FFTF) was 60-80% and the 5 year overall survival (OS) was 80-93%.
Aims
The current study assessed the outcome of patients diagnosed with stage I FL who were treated with radiotherapy with or without rituximab, in the PET-CT era.
Methods
Patients diagnosed with stage I FL based on PET-CT and bone marrow biopsy (BMB), who were treated with involved field radiotherapy between 2002-2015, were retrospectively reviewed in this multi-center study. Patients were treated with either radiation monotherapy or radiotherapy and rituximab.
Results
Ninety one patients from 9 centers were identified. The median age at diagnosis was 60 years (range: 31-93) years. FLIPI score was compatible with a low risk disease (0 or 1) in 93% and with an intermediate risk (FLIPI =2) in 7% of the patients. Forty eight percent of the patients had FL Grade 1, 39%>Grade 2 and 13% -Grade 3a FL, with 30% presenting with an extra-nodal disease. Median radiation dose was 30.2 (18-50) Gy. Most patients were treated with radiation monotherapy (71 patients, 78%), additional rituximab was administered to 20 patients (22%). Within a median follow-up of 57 months, the 5 year FFTF and OS survival rates were 76% and 97% respectively (Figure 1). Twenty one percent of the patients (n=19) experienced relapse; most relapses (n=14) were outside the radiation field. An intermediate risk FLIPI score was the only independent significant factor for a shorter FFTF [HR=2.3, 95% CI= 1.096 - 4.89, p=0.028].Radiation dose or adjuvant rituximab therapy did not significantly affect outcome.
Conclusion
Our findings show that staging with PET-CT and BMB of stage I FL may result in improved FFTF and OS in patients treated with radiotherapy compared to historical cohorts, possibly due to better identification of a true stage I disease. The distant nature of recurrences suggests that occult distant disease foci, not diagnosed even by PET-CT, are still possible.
Session topic: E-poster
Abstract: E1153
Type: Eposter Presentation
Background
Follicular lymphoma (FL) is the most common indolent non-Hodgkin Lymphoma. Treatment of stage I disease is usually radiation monotherapy, but debate over the role of additional chemo-immunotherapy exists. Most of the data on treatment and prognosis are based on retrospective historical cohorts before PET-CT was introduced into routine staging procedures. In these previous cohorts, 5 year freedom from treatment failure (FFTF) was 60-80% and the 5 year overall survival (OS) was 80-93%.
Aims
The current study assessed the outcome of patients diagnosed with stage I FL who were treated with radiotherapy with or without rituximab, in the PET-CT era.
Methods
Patients diagnosed with stage I FL based on PET-CT and bone marrow biopsy (BMB), who were treated with involved field radiotherapy between 2002-2015, were retrospectively reviewed in this multi-center study. Patients were treated with either radiation monotherapy or radiotherapy and rituximab.
Results
Ninety one patients from 9 centers were identified. The median age at diagnosis was 60 years (range: 31-93) years. FLIPI score was compatible with a low risk disease (0 or 1) in 93% and with an intermediate risk (FLIPI =2) in 7% of the patients. Forty eight percent of the patients had FL Grade 1, 39%>Grade 2 and 13% -Grade 3a FL, with 30% presenting with an extra-nodal disease. Median radiation dose was 30.2 (18-50) Gy. Most patients were treated with radiation monotherapy (71 patients, 78%), additional rituximab was administered to 20 patients (22%). Within a median follow-up of 57 months, the 5 year FFTF and OS survival rates were 76% and 97% respectively (Figure 1). Twenty one percent of the patients (n=19) experienced relapse; most relapses (n=14) were outside the radiation field. An intermediate risk FLIPI score was the only independent significant factor for a shorter FFTF [HR=2.3, 95% CI= 1.096 - 4.89, p=0.028].Radiation dose or adjuvant rituximab therapy did not significantly affect outcome.
Conclusion
Our findings show that staging with PET-CT and BMB of stage I FL may result in improved FFTF and OS in patients treated with radiotherapy compared to historical cohorts, possibly due to better identification of a true stage I disease. The distant nature of recurrences suggests that occult distant disease foci, not diagnosed even by PET-CT, are still possible.
Session topic: E-poster
Type: Eposter Presentation
Background
Follicular lymphoma (FL) is the most common indolent non-Hodgkin Lymphoma. Treatment of stage I disease is usually radiation monotherapy, but debate over the role of additional chemo-immunotherapy exists. Most of the data on treatment and prognosis are based on retrospective historical cohorts before PET-CT was introduced into routine staging procedures. In these previous cohorts, 5 year freedom from treatment failure (FFTF) was 60-80% and the 5 year overall survival (OS) was 80-93%.
Aims
The current study assessed the outcome of patients diagnosed with stage I FL who were treated with radiotherapy with or without rituximab, in the PET-CT era.
Methods
Patients diagnosed with stage I FL based on PET-CT and bone marrow biopsy (BMB), who were treated with involved field radiotherapy between 2002-2015, were retrospectively reviewed in this multi-center study. Patients were treated with either radiation monotherapy or radiotherapy and rituximab.
Results
Ninety one patients from 9 centers were identified. The median age at diagnosis was 60 years (range: 31-93) years. FLIPI score was compatible with a low risk disease (0 or 1) in 93% and with an intermediate risk (FLIPI =2) in 7% of the patients. Forty eight percent of the patients had FL Grade 1, 39%>Grade 2 and 13% -Grade 3a FL, with 30% presenting with an extra-nodal disease. Median radiation dose was 30.2 (18-50) Gy. Most patients were treated with radiation monotherapy (71 patients, 78%), additional rituximab was administered to 20 patients (22%). Within a median follow-up of 57 months, the 5 year FFTF and OS survival rates were 76% and 97% respectively (Figure 1). Twenty one percent of the patients (n=19) experienced relapse; most relapses (n=14) were outside the radiation field. An intermediate risk FLIPI score was the only independent significant factor for a shorter FFTF [HR=2.3, 95% CI= 1.096 - 4.89, p=0.028].Radiation dose or adjuvant rituximab therapy did not significantly affect outcome.
Conclusion
Our findings show that staging with PET-CT and BMB of stage I FL may result in improved FFTF and OS in patients treated with radiotherapy compared to historical cohorts, possibly due to better identification of a true stage I disease. The distant nature of recurrences suggests that occult distant disease foci, not diagnosed even by PET-CT, are still possible.
Session topic: E-poster
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