{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:36:38Z","timestamp":1761561398467},"reference-count":45,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2010,1,20]],"date-time":"2010-01-20T00:00:00Z","timestamp":1263945600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2010,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Combination immunochemotherapy is the most common approach for initial therapy of patients with advanced\u2010stage follicular lymphoma, but no consensus exists as to the optimal selection or sequence of available regimens. We undertook this decision analysis to systematically evaluate the parameters affecting the choice of early therapy in patients with this disease. We designed a Markov model incorporating the three most commonly utilized regimens (RCVP, RCHOP, and RFlu) in combinations of first\u2010 and second\u2010line therapies, with the endpoint of number of quality\u2010adjusted life years (QALYs) until disease progression. Data sources included Phase II and Phase III trials and literature estimates of long\u2010term toxicities and health state utilities. Meta\u2010analytic methods were used to derive the values and ranges of regimen\u2010related parameters. Based on our model, the strategy associated with the greatest number of expected quality\u2010adjusted life years was treatment with RCHOP in first\u2010line therapy followed by treatment with RFlu in second\u2010line therapy (9.00 QALYs). Strategies containing RCVP either in first\u2010 or second\u2010line therapy resulted in the lowest number of QALYs (range 6.24\u20137.71). Sensitivity analysis used to determine the relative contribution of each model parameter identified PFS after first\u2010line therapy and not short\u2010term QOL as the most important factor in prolonging overall quality\u2010adjusted life years. Our results suggest that regimens associated with a longer PFS provide a greater number of total QALYs, despite their short\u2010term toxicities. For patients without contraindications to any of these regimens, use of a more active regimen may maximize overall quality of life. Am. J. Hematol. 2010. \u00a9 2010 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ajh.21655","type":"journal-article","created":{"date-parts":[[2010,1,20]],"date-time":"2010-01-20T15:43:02Z","timestamp":1264002182000},"page":"255-260","source":"Crossref","is-referenced-by-count":8,"title":["Determinants of the optimal first\u2010line therapy for follicular lymphoma: A decision analysis"],"prefix":"10.1002","volume":"85","author":[{"given":"Rebecca L.","family":"Olin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter A.","family":"Kanetsky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas R.","family":"Ten Have","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunita D.","family":"Nasta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen J.","family":"Schuster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charalambos","family":"Andreadis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,3]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1986.4.10.1470"},{"key":"e_1_2_1_3_2","first-page":"697","article-title":"Quality of life in patients with low\u2010grade non\u2010Hodgkin's lymphoma","volume":"12","author":"Webster K","year":"1998","journal-title":"Oncology"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.18.1495"},{"key":"e_1_2_1_5_2","unstructured":"PRIMA trial website (GELA). Available at:http:\/\/prima.gela.org\/."},{"key":"e_1_2_1_6_2","volume-title":"Clinical decision analysis","author":"Weinstein MC","year":"1980"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-01-0338"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-127-12-199712150-00005"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V95.10.3057"},{"key":"e_1_2_1_10_2","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1182\/blood.V106.11.349.349","article-title":"Maintenance rituximab after CVP results in superior clinical outcome in advanced follicular lymphoma (FL): Results of the E1496 phase III trial from the Eastern Cooperative Oncology Group and the Cancer and Leukemia Group B","volume":"106","author":"Hochster HS","year":"2005","journal-title":"Blood"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-05-021113"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-04-016725"},{"key":"e_1_2_1_13_2","first-page":"75","article-title":"Natural history of and therapy for the indolent non\u2010Hodgkin's lymphomas","volume":"20","author":"Horning SJ","year":"1993","journal-title":"Semin Oncol"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.16.0283"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11407"},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/02841860601156165"},{"key":"e_1_2_1_17_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.06.033"},{"key":"e_1_2_1_18_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2005.12.006"},{"key":"e_1_2_1_19_2","first-page":"700","article-title":"Early and late infectious consequences of adding rituximab to fludarabine and cyclophosphamide in patients with indolent lymphoid malignancies","volume":"90","author":"Tam C","year":"2005","journal-title":"Haematologica"},{"key":"e_1_2_1_20_2","doi-asserted-by":"crossref","first-page":"3176","DOI":"10.1182\/blood.V112.11.3176.3176","article-title":"The frequency, manifestations and duration of prolonged cytopenias after first line fludarabine\u2010combination chemotherapy for chronic lymphocytic leukemia and Non\u2010Hodgkin lymphoma","volume":"112","author":"Gill SI","year":"2008","journal-title":"Blood"},{"key":"e_1_2_1_21_2","series-title":"Deaths: Final data for 2005. National vital statistics reports","author":"Kung HC","year":"2008"},{"key":"e_1_2_1_22_2","first-page":"463","article-title":"Cost\u2010effectiveness of ABMT in comparison with CHOP chemotherapy in patients with intermediate\u2010 and high\u2010grade malignant non\u2010Hodgkin's lymphoma (NHL)","volume":"16","author":"Uyl\u2010De Groot CA","year":"1995","journal-title":"Bone Marrow Transplant"},{"key":"e_1_2_1_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0609.2005.00438.x"},{"key":"e_1_2_1_24_2","doi-asserted-by":"publisher","DOI":"10.3109\/10428190109097655"},{"key":"e_1_2_1_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200006000-00004"},{"key":"e_1_2_1_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540150055031"},{"key":"e_1_2_1_27_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-01-0016"},{"key":"e_1_2_1_28_2","doi-asserted-by":"crossref","first-page":"4616","DOI":"10.1182\/blood.V104.11.4616.4616","article-title":"Rituximab plus CHOP followed by maintenance rituximab as initial therapy for advanced stage indolent non\u2010Hodgkin's lymphoma (NHL); Initial results of induction therapy in a phase II study","volume":"104","author":"Huang JE","year":"2004","journal-title":"Blood"},{"key":"e_1_2_1_29_2","doi-asserted-by":"crossref","first-page":"4584","DOI":"10.1182\/blood.V104.11.4584.4584","article-title":"How much rituximab do we need: A multicenter, randomized trial comparing 1, 3 or 6 infusions of rituximab added to 6 cycles of CHOP chemotherapy in untreated patients with advanced follicular non\u2010Hodgkins lymphoma (HD2000\u2010Trial)","volume":"104","author":"Hensel M","year":"2004","journal-title":"Blood"},{"key":"e_1_2_1_30_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2007-10-116749"},{"key":"e_1_2_1_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1349-7006.2006.00173.x"},{"key":"e_1_2_1_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0609.2007.00848.x"},{"key":"e_1_2_1_33_2","doi-asserted-by":"publisher","DOI":"10.1080\/10428190500472784"},{"key":"e_1_2_1_34_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.thj.6200229"},{"key":"e_1_2_1_35_2","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-03-0658"},{"key":"e_1_2_1_36_2","first-page":"1229","article-title":"Combined treatment with anti\u2010CD20 (rituximab) and CHOP in relapsed advanced\u2010stage follicular lymphomas","volume":"87","author":"Domingo\u2010Domenech E","year":"2002","journal-title":"Haematologica"},{"key":"e_1_2_1_37_2","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1182\/blood.V110.11.1278.1278","article-title":"Front\u2010line brief chemo\u2010immunotherapy rituximab (R)\u2010FND + rituximab consolidation rituximab maintenance in elderly patients with untreated advanced stage follicular lymphoma (FL): First interim analysis of a prospective randomized study (ML17638)","volume":"110","author":"Vitolo U","year":"2007","journal-title":"Blood"},{"key":"e_1_2_1_38_2","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1182\/blood.V104.11.1320.1320","article-title":"Sequential brief chemo\u2010immunotherapy FND + rituximab in elderly patients with advanced stage follicular lymphoma (FL): High clinical and molecular remission rate associated with a prolonged failure\u2010free survival","volume":"104","author":"Vitolo U","year":"2004","journal-title":"Blood"},{"key":"e_1_2_1_39_2","first-page":"2269","article-title":"Stage IV indolent lymphoma: A randomized study of concurrent vs. sequential use of FND chemotherapy (fludarabine, mitoxantrone, dexamethasone) and rituximab (R) monoclonal antibody therapy, with interferon maintenance","volume":"22","author":"Mclaughlin P","year":"2003","journal-title":"J Clin Oncol"},{"key":"e_1_2_1_40_2","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1182\/blood.V110.11.1286.1286","article-title":"Induction with fludarabine, cyclophosphamide and rituximab as front\u2010line therapy against follicular lymphoma: Results from a cooperative Spanish trial","volume":"110","author":"Tomas JF","year":"2007","journal-title":"Blood"},{"key":"e_1_2_1_41_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21882"},{"key":"e_1_2_1_42_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-04-1323"},{"key":"e_1_2_1_43_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22740"},{"key":"e_1_2_1_44_2","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1182\/blood.V106.11.941.941","article-title":"Rituximab, fludarabine, mitoxantrone, and dexamethasone (R\u2010FND) for relapsed indolent lymphomas (RIL)","volume":"106","author":"Hagemeister FB","year":"2005","journal-title":"Blood"},{"key":"e_1_2_1_45_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0609.2004.00293.x"},{"key":"e_1_2_1_46_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-08-3175"}],"container-title":["American Journal of Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fajh.21655","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajh.21655","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T03:38:08Z","timestamp":1700624288000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajh.21655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,3]]},"references-count":45,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2010,4]]}},"alternative-id":["10.1002\/ajh.21655"],"URL":"https:\/\/doi.org\/10.1002\/ajh.21655","archive":["Portico"],"relation":{},"ISSN":["0361-8609","1096-8652"],"issn-type":[{"value":"0361-8609","type":"print"},{"value":"1096-8652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,3]]}}}