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

Brian K. Link, Jonathan W. Friedberg, 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. Vase, Andrew D. Zelenetz

Research output: Contribution to journalArticle

195 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1202-1208
Number of pages7
JournalJournal of Clinical Oncology
Volume27
Issue number8
DOIs
StatePublished - Mar 10 2009

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Follicular Lymphoma
Therapeutics
Vincristine
Prednisone
Drug Therapy
Cyclophosphamide
Radiotherapy
Standard of Care
Practice Guidelines
Doxorubicin
Observational Studies
Longitudinal Studies
Rituximab
Patient Care
Cohort Studies
Observation
Demography
Clinical Trials
Prospective Studies
Recurrence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Link, B. K., Friedberg, J. W., Taylor, M. D., Cerhan, J. R., Flowers, C. R., Dillon, H., ... Zelenetz, A. D. (2009). Follicular lymphoma in the United States: First report of the national LymphoCare study. Journal of Clinical Oncology, 27(8), 1202-1208. https://doi.org/10.1200/JCO.2008.18.1495

Follicular lymphoma in the United States : First report of the national LymphoCare study. / Link, Brian K.; Friedberg, Jonathan W.; Taylor, Michael D.; Cerhan, James R; Flowers, Christopher R.; Dillon, Hildy; Farber, Charles M.; Rogers, Eric S.; Hainsworth, John D.; Wong, Elaine K.; Vase, Julie M.; Zelenetz, Andrew D.

In: Journal of Clinical Oncology, Vol. 27, No. 8, 10.03.2009, p. 1202-1208.

Research output: Contribution to journalArticle

Link, BK, Friedberg, JW, Taylor, MD, Cerhan, JR, Flowers, CR, Dillon, H, Farber, CM, Rogers, ES, Hainsworth, JD, Wong, EK, Vase, JM & Zelenetz, AD 2009, 'Follicular lymphoma in the United States: First report of the national LymphoCare study', Journal of Clinical Oncology, vol. 27, no. 8, pp. 1202-1208. https://doi.org/10.1200/JCO.2008.18.1495
Link, Brian K. ; Friedberg, Jonathan W. ; Taylor, Michael D. ; Cerhan, James R ; Flowers, Christopher R. ; Dillon, Hildy ; Farber, Charles M. ; Rogers, Eric S. ; Hainsworth, John D. ; Wong, Elaine K. ; Vase, Julie M. ; Zelenetz, Andrew D. / Follicular lymphoma in the United States : First report of the national LymphoCare study. In: Journal of Clinical Oncology. 2009 ; Vol. 27, No. 8. pp. 1202-1208.
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title = "Follicular lymphoma in the United States: First report of the national LymphoCare study",
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.",
author = "Link, {Brian K.} and Friedberg, {Jonathan W.} and Taylor, {Michael D.} and Cerhan, {James R} and Flowers, {Christopher R.} and Hildy Dillon and Farber, {Charles M.} and Rogers, {Eric S.} and Hainsworth, {John D.} and Wong, {Elaine K.} and Vase, {Julie M.} and Zelenetz, {Andrew D.}",
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T2 - First report of the national LymphoCare study

AU - Link, Brian K.

AU - Friedberg, Jonathan W.

AU - Taylor, Michael D.

AU - Cerhan, James R

AU - Flowers, Christopher R.

AU - Dillon, Hildy

AU - Farber, Charles M.

AU - Rogers, Eric S.

AU - Hainsworth, John D.

AU - Wong, Elaine K.

AU - Vase, Julie M.

AU - Zelenetz, Andrew D.

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N2 - 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.

AB - 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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