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. 2009 Mar 10;27(8):1202-8.
doi: 10.1200/JCO.2008.18.1495. Epub 2009 Feb 9.

Follicular lymphoma in the United States: first report of the national LymphoCare study

Jonathan W Friedberg  1 , Michael D Taylor, James R Cerhan, Christopher R Flowers, Hildy Dillon, Charles M Farber, Eric S Rogers, John D Hainsworth, Elaine K Wong, Julie M Vose, Andrew D Zelenetz, Brian K Link
Affiliations

Follicular lymphoma in the United States: first report of the national LymphoCare study

Jonathan W Friedberg et al. J Clin Oncol. .

Abstract

Purpose: Optimal 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 methods: The 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.

Results: Two 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.

Conclusion: Widely 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.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Sites and enrollment by region.
Fig 2.
Fig 2.
Missing elements in Follicular Lymphoma International Prognostic Index scores for entire cohort. LDH, lactate dehydrogenase.
Fig 3.
Fig 3.
Follicular Lymphoma International Prognostic Index (FLIPI) distribution, (A) overall, and (B) stratified by grade, age, and stage. NLCS, National LymphoCare study.
Fig 4.
Fig 4.
Initial treatment, (A) all, and (B) stage I patients.
See this image and copyright information in PMC

Comment in

  • A look in the mirror.
    McLaughlin P. McLaughlin P. J Clin Oncol. 2009 Mar 10;27(8):1158-9. doi: 10.1200/JCO.2009.19.8655. Epub 2009 Feb 9. J Clin Oncol. 2009. PMID: 19204191 No abstract available.

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