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Originally published as JCO Early Release 10.1200/JCO.2008.18.1495 on February 9 2009 © 2009 American Society of Clinical Oncology.
Follicular Lymphoma in the United States: First Report of the National LymphoCare StudyFrom the James P. Wilmot Cancer Center, University of Rochester, Rochester; The Leukemia & Lymphoma Society, White Plains; Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech Inc, South San Francisco, CA; Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN; Emory University, Atlanta, GA; Medical Oncology, Simon Cancer Center, Morristown, NJ; University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, WI; Medical Oncology, Sarah Cannon Research Institute, Nashville, TN; Internal Medicine, Nebraska Medical Center, Omaha, NE; and Internal Medicine, University of Iowa, Iowa City, IA. Corresponding author: Brian K. Link, MD, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, C32 GH, Iowa City, lA 52242; e-mail: Brian-link{at}uiowa.edu. 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. Supported in part by a Career Development Award from the National Cancer Institute (CA-102216 to J.W.F.); the National LymphoCare Study is funded by Genentech Inc and Biogen Idec. Presented in part in abstract format at the 47th Annual Meeting of the American Society of Hematology, Atlanta, December 10–13, 2005; Atlanta, GA; 42nd Annual Meeting of the American Society of Clinical Oncology, June 2–6, 2006, Atlanta, GA; and 49th Annual Meeting of the American Society of Hematology, December 8–11, 2007, Atlanta, GA. Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article. Clinical trial information can be found for the following: NCT00097565 [ClinicalTrials.gov] .
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Copyright © 2009 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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