Treatment patterns in low-grade non-Hodgkin's lymphomas: a single institution study

Ninety-two cases of low-grade non-Hodgkin's lymphoma were examined retrospectively to assess to what extent treatment deferral is practiced at a single university hospital with a local referral base. Clinical characteristics of this patient group were also analyzed; 70% of these cases were of nodular lymphocytic, poorly differentiated (NLPD) histology, and 74% were stage III or IV. Twenty-two cases were not treated initially. Nine eventually required treatment at a median of 16 months. Survival did not differ based on whether treatment was initially deferred. Nodal progression was the most common reason for beginning treatment after initial deferral, and most cases of advanced stage disease required treatment because of nodal involvement or B-type symptoms at diagnosis. Presence of intra-abdominal adenopathy often prompted initial treatment even in asymptomatic cases. In this series, as compared to previously reported series of treatment-deferred cases, more patients were judged to require treatment at disease outset, and the median time to treatment in those in whom treatment was initially deferred but then instituted was shorter. Despite this, for the entire population, 69% of total follow-up time was spent off therapy.