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Delaying Chemotherapy Could Be Best Treatment Option For Certain Type Of Non-hodgkin Lymphoma (p 516)
August 13, 2003Delaying chemotherapy until symptoms develop for patients with asymptomatic advanced low-grade non-Hodgkin lymphoma is confirmed as an appropriate strategy authors of a UK study in this week's issue of THE LANCET.
Chemotherapy (single or aggressive combination therapy) does not cure advanced stage low-grade non-Hodgkin lymphomas, even when combined with radiotherapy. On behalf of the British National Lymphoma Investigation, Kirit Ardeshna from the Mount Vernon Cancer Centre, Northwood, UK, and colleagues compared administration of immediate chemotherapy (chlorambucil) with a policy of delaying chemotherapy until clinical progression necessitated its use, in patients with asymptomatic advanced-stage, low-grade non-Hodgkin lymphoma.
309 patients were recruited from 44 UK centres between 1981 and 1990. Half the patients were randomised to receive immediate chemotherapy with oral chlorambucil (10 mg per day); the other half were randomised to an initial policy of 'wait and see', with chemotherapy delayed until disease progression. Local radiotherapy was given to both groups if lymph nodes showed evidence of disease.
The Average follow-up of patients was 16 years, and patients randomised to a 'wait and see' policy required chemotherapy after an average of two and a half years. There was no difference in overall survival (around six years) and survival specific to non-Hodgkin lymphoma (around nine years) between the two groups. People in the 'wait and see' group had around a 20% chance of not requiring chemotherapy after 10 years; this was doubled to 40% of people not requiring chemotherapy for patients over 70 years of age.
Kirit Ardeshna comments: "An initial policy of watchful waiting in patients with asymptomatic, advanced stage low-grade non-Hodgkin lymphoma is appropriate, especially in patients aged over 70 years."
Lancet
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