Originally published as JCO Early Release 10.1200/JCO.2004.10.086 on March 15 2004

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Stage I and II Follicular Non-Hodgkin’s Lymphoma: Long-Term Follow-Up of No Initial Therapy

From the Division of Oncology, Department of Medicine, Stanford University Medical Center, Stanford, CA

Address reprint requests to Ranjana Advani, MD, Division of Oncology, 875 Blake Wilber Dr, Stanford, CA 94305; e-mail: radvani{at}stanford.edu

PURPOSE: To analyze the outcome of no initial therapy in stage I and II follicular small-cleaved (FSC) and follicular mixed (FM) non-Hodgkin’s lymphoma (NHL) on overall survival, time to treatment, incidence and course of transformation, and cause of death.

PATIENTS AND METHODS: This was a retrospective analysis. Criteria for selection were patients with stage I and IIA FSC and FM (grades 1 and 2) NHL with therapy deferred for at least 3 months after diagnosis and a minimum follow-up of 1 year.

RESULTS: Forty-three patients were identified (11 stage I, 32 stage II), with a median age of 58 years. Reasons for no initial therapy included: physician choice (n = 20), large abdominal radiation field required (n = 10), advanced age (n = 7), concern for xerostomia (n = 4), or patient refusal (n = 2). At a median follow-up of 86 months, 27 patients (63%) had not been treated. The median time to treatment in the remaining 16 patients was 22 months. Four of 16 patients transformed to a higher-grade lymphoma. Nine patients died—six due to progressive lymphoma. Estimated survivals at 5, 10, and 20 years were 97%, 85%, and 22%, respectively.

CONCLUSION: In selected stage I and II follicular NHL patients, deferred therapy is an acceptable approach, as more than half of our patients remained untreated at a median of 6 or more years, and survival was comparable to that seen in reports with immediate treatment.

Supported in part by National Institutes of Health grant No. CA34233.

Presented at the 8th International Conference on Malignant Lymphomas, Lugano, Switzerland, June 12-15, 2002.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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