Clinical outcomes with use of radiation therapy and risk of transformation in early-stage follicular lymphoma

Fushen Sha, Michelle Okwali, Anna Alperovich, Philip C. Caron, Lorenzo Falchi, Audrey Hamilton, Paul A. Hamlin, Steven M. Horwitz, Erel Joffe, Niloufer Khan, Anita Kumar, Matthew J. Matasar, Alison J. Moskowitz, Ariela Noy, Colette Owens, Lia M. Palomba, Ildefonso Rodriguez-Rivera, David Straus, Gottfried von Keudell, Andrew D. ZelenetzJoachim Yahalom, Ahmet Dogan, Heiko Schöder, Venkatraman E. Seshan, Gilles Salles, Anas Younes, Connie L. Batlevi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Between 1998 and 2009, a total of 295 patients (median age 58, 53% females) with newly diagnosed early-stage follicular lymphoma (FL) were managed at Memorial Sloan Kettering Cancer Center. Approximately half of patients (137, 46%) underwent initial observation and half (158, 54%) immediate treatment: radiation alone (n = 108), systemic treatment alone (n = 29), or combined modality treatment (n = 21). Median follow-up was 8.4 years (range 0.3–17.2), and 10-year overall survival (OS) was 87.2%. OS was similar between initially-observed and immediately-treated patients (hazard ratio [HR]: 1.25, 95% CI: 0.67–2.36, p = 0.49). For patients receiving radiation alone, 5-year OS was 98.0%. Patients selected for systemic therapy alone had high-risk baseline features and had shorter OS than patients treated with radiation alone (HR 3.38, 95% CI 1.29–8.86, p = 0.01). Combined modality treatment did not yield superior survival compared with radiation alone (P > 0.05) but was associated with better progression-free survival (HR 0.36, 95% CI 0.14–0.90, p = 0.03). The rate of transformation increased steadily over time and was 4.2% at 5 years and 10.8% at 10 years. This modern-era analysis rationalized the role of initial observation in patients with early-stage FL although patients receiving radiation therapy also demonstrate excellent outcome.

Original languageEnglish
Article number29
JournalBlood Cancer Journal
Issue number2
StatePublished - Feb 2022
Externally publishedYes


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