Doctors Choose Variety of Treatments for Follicular Lymphoma

Mar. 8, 2009
Jonathan Friedberg, M.D., specializes in lymphoma care and research.

People with follicular lymphoma are treated in a wide variety of ways depending on their physician’s preference and the region of the country that they live, according to scientists at the University of Rochester Medical Center who analyzed the largest prospective registry of patients with follicular lymphoma.

The study, published on the Journal of Clinical Oncology website, shows there are many ways to treat the disease, which is incurable in the advanced stages, because no gold-standard regimen has been widely accepted.

However, new therapies that include monoclonal antibodies such as rituximab, in combination with chemotherapy, have significantly improved overall survival in the past decade are now routinely incorporated into treatment regimens.

Scientists analyzed data on more than 2,700 patients newly diagnosed with follicular lymphoma who were enrolled in the National LymphoCare Study, a multicenter observational study designed to collect detailed information on treatments and outcomes for people with follicular lymphoma. The national database is funded by Genentech and Biogen Idec, but scientists, publishing the results had full access to data and independently wrote the manuscript.

Follicular lymphoma is the second most common form of non Hodgkin’s lymphoma in the United States, and affects more than 15,000 people per year. Like other lymphomas it has significantly increased in incidence over the past three decades. Approximately 20 percent of the patients are diagnosed at early stages.

In the LymphoCare registry, common treatment approaches for early stage disease ranged from “watchful waiting,” or observation without active therapy – recorded in about 25 percent of patients with Stage 1 or Stage 2 disease, to more aggressive approaches including chemotherapy and radiation therapy.

“The treatment decisions that doctors make at the onset of disease are critical because they impact how the patient can be treated later, as follicular lymphoma progresses,” said lead author Jonathan Friedberg, M.D., chief of hematology/oncology at Rochester’s James P. Wilmot Cancer Center.

The common choice of deferred therapy for patients with Stage 1 and Stage 2 disease was concerning to Peter McLaughlin, M.D., deputy chair of Lymphoma/Myeloma at M.D. Anderson Cancer Center at the University of Texas, who wrote an accompanying editorial on the research.

“One of the cornerstones of the ‘watch and wait’ argument is the incurability of advanced stage follicular lymphoma,” he wrote. Early stage disease “is a conspicuous exception since cure is possible in almost half of patients” who receive radiation therapy. The National Comprehensive Cancer Network also recommends treatment for people with early disease, only choosing to defer care if there are other health issues to address.

Patients with the more common presentation of advanced stage disease also were treated with a variety of approaches. 

“It is clear from the study that there is no ‘standard of care’ for patients with newly diagnosed follicular lymphoma,” Friedberg said. This has important implications on developing future treatments, and performing clinical trials. In the future, outcome data from the registry can compare these different treatment approaches, helping to determine an optimal approach.