The role of "watch and wait" in intestinal follicular lymphoma in rituximab era. (3rd March 2016)

• Record Type: Journal Article
• Authors: Tari, Akira; Asaoku, Hideki; Takata, Katsuyoshi; Fujimori, Shunji; Tanaka, Shinji; Fujihara, Megumu; Koga, Tadashi; Yoshino, Tadashi
• Is Part Of: Scandinavian journal of gastroenterology. Volume 51:Number 3(2016)
• Page Start: 321
• Page End: 328
• Publication Date: 2016-03-03
• Subjects: histologic transformation -- intestinal follicular lymphoma -- low-tumor-burden -- treatment -- watch and wait; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.3109/00365521.2015.1087589
• Languages: English
• ISSNs: 0036-5521

Abstract

Abstract: Objective : There is no consensus regarding the best treatment for intestinal follicular lymphoma (FL). We used "watch and wait" for patients with intestinal FL with low-tumor-burden (LTB) criteria and without mass formation causing bowel obstruction. We investigated the overall survival (OS) and time to treatment required (TTR). Methods : Thirty-three intestinal FL patients [clinical stage (CS) I:16, II1:0, II2:7, IV:10; median observation period: 45.5 months, range: 13–110 months] were diagnosed via endoscopy. Detailed clinical and pathological examinations were performed, and neoplastic process behavior was monitored. Results : All of the 33 patients were WHO grade 1. FL lesions in the digestive tract were found frequently in the second–fourth portion of the duodenum in 91% of the patients; 87% of those patients had lesions in a broader area including the small intestine. Two patients had an enlargement of the area of the lesions and a worsening of the macroscopic findings. Three patients had CS progression; however, these remained within the indication for "watch and wait." Two patients with transformation into diffuse large B-cell lymphoma received rituximab and chemotherapy, which led to complete remission. The OS was 100%. The time to treatment required (TTR) was 49 months in one patient and 37 months in one patient. Conclusion : Intestinal FL in CS I–IV with broad infiltration of the digestive tract meeting the criteria for LTB had a remarkably slow course. This study suggests that "watch and wait" is appropriate for the treatment of LTB intestinal FL even in the era of rituximab.