{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:14:17Z","timestamp":1761844457073},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,11,19]],"date-time":"2014-11-19T00:00:00Z","timestamp":1416355200000},"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":[[2015,1]]},"abstract":"<jats:p>Follicular lymphoma (FL) patients experience multiple remissions and relapses and commonly receive multiple treatment lines. A crucial question is whether anthracyclines should be used at first\u2010line or whether they would be better \u201creserved\u201d for relapse and whether FL outcome can be optimized by definite sequences of treatments. Randomized trials can be hardly designed to address this question. In this retrospective multi\u2010institutional study, time\u2010to\u2010next\u2010treatment after first relapse was analyzed in 510 patients who had received either alkylating agents\u2010 or anthracycline\u2010 or nucleoside analogs\u2010based chemotherapy with\/without rituximab at first\u2010line and different second\u2010line therapies. After a median of 42 months, median time\u2010to\u2010next\u2010treatment after relapse was 41 months (CI95%:34\u201347 months). After adjustment for covariates, first\u2010line anthracycline\u2010based chemotherapy with\/without rituximab was associated with better time\u2010to\u2010next\u2010treatment after any salvage than alkylating agents\u2010based chemotherapy with\/without rituximab or nucleoside analogs\u2010based chemotherapy with\/without rituximab (HR:0.74,<jats:italic>P<\/jats:italic>\u2009=\u20090.027). The addition of rituximab to first\u2010line chemotherapy had no significant impact (HR:1.22,<jats:italic>P<\/jats:italic>\u2009=\u20090.140). Autologs stem cell transplantation performed better than any other salvage treatment (HR:0.53,<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). First\u2010line anthracycline\u2010based chemotherapy significantly improved time\u2010to\u2010next\u2010treatment even in patients receiving salvage autologs stem cell transplantation (<jats:italic>P<\/jats:italic>\u2009=\u20090.041). This study supports the concept that in FL previous treatments significantly impact on the outcome of subsequent therapies. The outcome of second\u2010line treatments, either with salvage chemoimmunotherapy or with autologs stem cell transplantation, was better when an anthracycline\u2010containing regimen was used at first\u2010line. Am. J. Hematol. 90:56\u201361, 2015. \u00a9 2014 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ajh.23872","type":"journal-article","created":{"date-parts":[[2014,10,17]],"date-time":"2014-10-17T10:20:05Z","timestamp":1413541205000},"page":"56-61","source":"Crossref","is-referenced-by-count":4,"title":["The use of anthracycline at first\u2010line compared to alkylating agents or nucleoside analogs improves the outcome of salvage treatments after relapse in follicular lymphoma The REFOLL study by the Fondazione Italiana Linfomi"],"prefix":"10.1002","volume":"90","author":[{"given":"Giuseppe","family":"Rossi","sequence":"first","affiliation":[{"name":"Division of Hematology Spedali Civili Brescia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Marcheselli","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Clinical and Public Health Medicine University of Modena and Reggio Emilia Modena 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