Limited stage I and II follicular non-Hodgkin's lymphoma: The Nebraska Lymphoma Study Group experience

The purpose of this study was to evaluate the outcome and prognostic factor s of patients with limited stage follicular non-Hodgkin's lymphoma treated prospectively by the Nebraska Lymphoma Study Group (NLSG). Forty previously untreated patients, median age 64 years, with limited stage follicular lym phoma were prospectively treated according to the protocols of the NLSG bet ween January 1980 and December 1990. The follicular large cell type represe nts 75% of the cases, and 14 of the biopsies also had a diffuse component ( composite lymphoma). The initial treatment was radiation therapy (RT) to th e involved field in 15 patients, anthracycline-containing combination chemo therapy (CT) in 20, and combined RT and CT in 5. Thirty-seven patients (92. 5%) achieved a complete remission (CR). The median follow-up is 120 months (range, 20 to 214). Of the 37 patients achieving a CR, 7 patients are alive in first CR, one died due to sepsis, another because of a myeloproliferati ve disorder at 77 months following chemotherapy, 6 died because of unrelate d causes in first CR. Twenty-two patients relapsed between 1 to 128 months following a CR. The estimated 10-year event-free survival is 21% (95% Cl : 7 to 35). Two patients received no or palliative therapy after relapse and both died of progressive disease. Nineteen patients received salvage therap y and 15 achieved a second remission. The median survival after first relap se is 55 months. The estimated 10-year overall survival is 44% (95% Cl : 28 to 60). Various factors including sex, histologic subtype, stage, and degr ee of follicularity do not influence the overall survival or event-free sur vival. CT with or without RT resulted in a better trend for 10-year event-f ree survival in stage IA patients compared to RT alone but estimated 10-yea r overall survival is no different. The overall survival is worse in the gr eater than or equal to 60 age group but this difference is not evident if d ata is adjusted for cause specific death. In conclusion, limited stage foll icular lymphoma has an excellent initial response to radiation therapy or c hemotherapy; however the recurrence rate is high and cure is limited.