Watch-and-wait policy versus rituximab-combined chemotherapy in Japanese patients with intestinal follicular lymphoma

Akira Tari, Yasuhiko Kitadai, Ritsuo Mouri, Hidehiko Takigawa, Hideki Asaoku, Keiichiro Mihara, Katsuyoshi Takata, Megumu Fujihara, Tadashi Yoshino, Tadashi Koga, Shunji Fujimori, Shinji Tanaka, Kazuaki Chayama

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6 Citations (Scopus)

Abstract

Background and Aim: Few reports have demonstrated the effectiveness of treatments for intestinal follicular lymphoma (FL) because of the limited number of patients who undergo comprehensive small intestinal examinations. This study compared the efficacy of rituximab-combined chemotherapy in patients with asymptomatic and low tumor burden (LTB) intestinal FL, according to the criteria of the Groupe d'Etude des Lymphomes Folliculaires, with that of a "watch and wait" (W&W) approach. Methods: The endoscopic examination for entire gastrointestinal tracts was performed in 29 Japanese patients with intestinal FL. These patients had CD21-positive follicular dendritic cells arranged in a duodenal pattern. In a prospective, two-center, open-label trial, this study evaluated the efficacy of rituximab-combined chemotherapy ([cyclophosphamide, doxorubicin, vincristine, and prednisone] or [cyclophosphamide, vincristine, and prednisone]) and prolonged treatment with rituximab (R-Chemo+prolongedR) in 14 patients and compared their outcomes with those of 15 patients managed with a W&W approach. Results: Four patients managed with the W&W plan showed worsening macroscopic findings, lesion area enlargement, or clinical stage progression but stayed on this plan because they had LTB and experienced no changes in bowel function. In the R-Chemo+prolongedR group, all patients achieved complete remission; recurrence occurred in one patient, who was subsequently managed with the W&W plan because of LTB. There were no significant differences in progression-free survival between the two groups (P = 0.1045). Overall survival was 100% in both groups. Conclusions: The prognoses of patients with asymptomatic intestinal FL and LTB who were managed with a W&W strategy were comparable with those of patients receiving R-Chemo+prolongedR.

Original languageEnglish
JournalJournal of Gastroenterology and Hepatology (Australia)
DOIs
Publication statusAccepted/In press - Jan 1 2018

Keywords

  • Intestinal follicular lymphoma
  • Low tumor burden
  • Rituximab-combined chemotherapy
  • Treatment
  • Watch and wait

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Tari, A., Kitadai, Y., Mouri, R., Takigawa, H., Asaoku, H., Mihara, K., Takata, K., Fujihara, M., Yoshino, T., Koga, T., Fujimori, S., Tanaka, S., & Chayama, K. (Accepted/In press). Watch-and-wait policy versus rituximab-combined chemotherapy in Japanese patients with intestinal follicular lymphoma. Journal of Gastroenterology and Hepatology (Australia). https://doi.org/10.1111/jgh.14100