Still No "Best" Trestment for Early Stage FL

According to research presented in the journal Blood Advances, there is still no "best" treatment for early stage Follicular Lymphoma.

I don't write a lot about early stage (stage 1 or 2) FL, for a couple of reasons. First, not many FL patients have it. Most of us are diagnosed with stage 3 or 4 disease. Less than 20% of us are diagnosed with early stage disease. Symptoms just don't show up very clearly at those stages.

The other reason is that there really isn't a lot of research on early stage disease. For many years, the thinking has been that early stage FL can actually be cured, in many cases, with traditional radiation. It makes sense -- staging is based on location. Stage 1 lymphoma is isolated to one area of the body. Radiation doesn't work on other stages because a single radiation beam can't get to it. But it can with stage 1.

But is that the best approach? That's what the Blood Advances article tried to answer.

The article is called "Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance."

The research looked at how effective a bunch of different treatments were on stage 1 and 2 Follicular Lymphoma -- Watching and waiting, radiation alone, systemic therapy (like chemotherapy), or  chemo + maintenance.

The big outcome is that they found that there was no difference in Overall Survival among all of the choices.

This is not a surprise. It's the golden ring that no one seems to be able to grab -- lots of treatments seem to do good things for FL patients, like increase time between treatments, or do the job with fewer side effects. But all of them seem to give the same survival benefit. They can do different things for us, but in the end, none of them keep us alive any longer than the next best one.

The patients that received Maintenance had better Progression-Free Survival. Again, not a surprise. That seems to be the case with many studies -- Maintenance keeps the disease from coming back longer than not getting Maintenance (though it does come with the side effects that come with long-term treatment). Better PFS, but with the same Overall Survival.  

The good news is that all of the different treatments resulted in "excellent outcomes."

And that's about where we are, still, with Follicular Lymphoma, with a few exceptions. We have lots of options, which lets us choose treatment based on our goals. The important thing is to know what those options are, know what your goals are, and have a doctor who is willing to talk about it all with you.