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Treatments > Frontline Treatments for indolent lymphomas

Last update: 10/27/2004

This is a work in progress.

Discussion: There is no standard treatment for indolent lymphomas. Watch & wait (deferring treatment) is often recommended at diagnosis. When treatment is indicated - typically when you are symptomatic or prior to developing bulky disease - a treatment listed in this table might be recommended. 

In this table, time to progress (TTP/EFS mo) numbers are based on studies you can access by clicking the number of months. TTP with an asterisk (*) are from studies that have statistically significant data. Be aware that when the goal of treatment is management, lower TTP are expected. Increased TTP does not necessrily predict improved survival 

KEY: CR = Complete Response |  Tx = Treatment | m = Maintenance | x4 = 4 rounds | 
TTP = Time to Progression | Mng = Management | D = durable remission / cure

Options for follicular NHL

Goal 
of Tx

TTP/EFS
mo

Response notes Notes

Related
articles

Prednisone Mng fast acting toxicity with extended use articles
Rituxan x4 Mng

TTP 
12

54%; 14 pts 36% stable or minor response More specific, less toxic than 
chemo; effect on overall 
 survival unknown 
 articles
Rituxan x4 / x8 /m Mng

TTP 
34

56% (8% CR). while promising, affect on overall 
survival is unknown 
 articles
Rituxan x4 / x8 Mng

EFS
36

Event-free survival (EFS) was 12 months in the no further treatment arm vs. 23 months in the prolonged treatment arm (p=0.02), the difference being particularly notable in chemotherapy-naive patients (19 vs. 36 months, p=0.009) and in patients responding to induction treatment (16 vs. 36 months, p=0.004). Blood. 2004 Feb 19 PMID: 14976046

articles

Rituxan + gm-csf x4/x8/m Mng

-

20 patients with relapsed disease, the combination of granulocyte-colony stimulating factor with rituximab resulted in a longer duration of response than normally seen with rituximab monotherapy. - Kimby articles
Rituxan + IL-2  Mng

-

articles
Rituxan + Prednisone  Mng

-

articles
Rituxan + Interferon-alpha  Mng

TTP 
22.3 and 25.2

Data for relapsed setting. INF-alpha can cause unpleasant side effects.  articles
Rituxan + Pentostatin Mng

TTP 
15

77% responded - 22.3% CR; 
Previously untreated vs previously
  treated pts was 83% vs 63%
articles
Rituxan + Fludarabine
 articles
Radiotherapy, localized D

For stage I and II can 
be curative (C)
surviving patients ranged from 
3.5 to 28.7 years (median 19.0)
 articles
 articles
Chlorambucil Mng  articles
Fludarabine D

Fludarabine, cyclophosphamide and mitoxantrone for untreated follicular lymphoma: a report from the non-Hodgkin's lymphoma co-operative study group. Leuk Lymphoma. 2004 Jun;45(6):1141-7.  PMID: 15359993 Related articles
CVP / COP Mng/D articles
Combination chemo 
with adjuvant radiotherapy
 to bulky nodes
D 71% survival at 20 years for 
pts with advanced disease 
Intriguing report, Some experts
 question methodology.
articles
related articles
CVP + Rituxan D

TTP
32

CVP chemotherapy plus Rituximab compared with CVP as first-line treatment for advanced follicular lymphoma.  [322 patient study] Blood. 2004 Oct 19 PMID: 15494430 |     Overall and complete response rates were
81% and 41% in the R-CVP arm vs. 57% and 10% in the CVP arm, respectively (P < 0.0001).  Median Time to progression: 32 months vs. 15 months for CVP; P < 0.0001).
Related articles
Chlorambucil + Rituxan Mng  (PMID: 14531908) articles
Rituxan > Chlorambucil 
(added if needed)
Mng none
MC + Rituxan  D

TTP 
30

PMID: 14579238 articles
FCM + Rituxan D

PMID: 12652460  articles
CNOP + Rituxan  D

PMID: 12750729 articles
FND + Rituxan  D

PMID: 11225999 articles
CHOP + Rituxan  D

TTP 
82

Prolonged Clinical and Molecular Remission in Patients With Low-Grade or Follicular Non-Hodgkin's Lymphoma Treated With Rituximab Plus CHOP Chemotherapy: 9-Year Follow-Up. J Clin Oncol. 2004 Oct 13   articles
Rituxan > FavId vaccine  Mng/D articles
CVP > vaccine vs. 
CVP > control 
D articles
CHOP+Bexxar vs. CHOP+Rituxan  D articles
 F is Fludarabine |  M/N is Mitoxantrone | C is Cyclophosphamide |  D is Dexamethasone |  V/O is Vincristine |  P is Prednisone |  H is Doxorubicin
 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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