{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:08:35Z","timestamp":1791418115012,"version":"4.3.3"},"reference-count":47,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"33","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2018,11,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> For indolent lymphoma, the optimal timing, sequence, and choice of therapeutic regimens remain a matter of debate. In two Nordic Lymphoma Group randomized trials, symptomatic or clearly progressing patients were treated first line with a rituximab-containing regimen without chemotherapy. The purpose of this study was to assess long-term survival, risk of transformation, and need of new therapies. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> Data were collected at cross-sectional follow-up for 321 patients with indolent lymphoma (84% with follicular lymphomas [FL]) included in one of two Nordic Lymphoma Group trials (accrual 1998 to 1999 and 2002 to 2008). All patients received first-line therapy with one or two cycles of four weekly infusions of rituximab 375 mg\/m<jats:sup>2<\/jats:sup>, and 148 were randomly allocated to the addition of interferon alfa-2a. Follow-up data were retrieved from initial trial databases and medical records on repeated clinical evaluations. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> At the end of follow-up, 73% of patients were alive, with a median follow-up after random assignment of 10.6 years. Among all, 36% (38% with FL) had never needed chemotherapy. For patients with FL who required new therapy within 24 months because of early disease progression, the 10-year survival rate was 59% versus 81% for those with longer remission. Interferon was not shown to improve long-term outcome. Transformation was diagnosed in 20% of all patients (2.4% per person-year) and in 18% with FL. An additional malignancy was found in 12%. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> Approximately one third of patients with symptomatic indolent lymphoma (30% with FL, 23% without FL) did not need new therapy in the long term after first-line rituximab without chemotherapy. In the entire cohort, 10-year survival was excellent with no major safety issues, which suggests that chemotherapy can be delayed safely in the majority of patients. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.18.00262","type":"journal-article","created":{"date-parts":[[2018,10,4]],"date-time":"2018-10-04T20:00:48Z","timestamp":1538683248000},"page":"3315-3323","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":51,"title":["Chemotherapy-Free Initial Treatment of Advanced Indolent Lymphoma Has Durable Effect With Low Toxicity: Results From Two Nordic Lymphoma Group Trials With More Than 10 Years of Follow-Up"],"prefix":"10.1200","volume":"36","author":[{"given":"Sandra","family":"Lockmer","sequence":"first","affiliation":[{"name":"Sandra Lockmer, Bj\u00f6rn Engelbrekt Wahlin, Karin Ekstr\u00f6m Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Bj\u00f6rn Engelbrekt Wahlin, and Karin Ekstr\u00f6m Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Ume\u00e5, Sweden; Bj\u00f8rn \u00d8stenstad and Harald Holte, Oslo University Hospital; Chlo\u00e9 Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rn","family":"\u00d8stenstad","sequence":"additional","affiliation":[{"name":"Sandra Lockmer, Bj\u00f6rn Engelbrekt Wahlin, Karin Ekstr\u00f6m Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Bj\u00f6rn Engelbrekt Wahlin, and Karin Ekstr\u00f6m Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Ume\u00e5, Sweden; Bj\u00f8rn \u00d8stenstad and Harald Holte, Oslo University Hospital; Chlo\u00e9 Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Hagberg","sequence":"additional","affiliation":[{"name":"Sandra Lockmer, Bj\u00f6rn Engelbrekt Wahlin, Karin Ekstr\u00f6m Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Bj\u00f6rn Engelbrekt Wahlin, and Karin Ekstr\u00f6m Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Ume\u00e5, Sweden; Bj\u00f8rn \u00d8stenstad and Harald Holte, Oslo University Hospital; Chlo\u00e9 Beate Steen, University of Oslo, Oslo; Karin Fahl Wader, St Olavs Hospital, Trondheim; Peter Meyer, Stavanger University..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Holte","sequence":"additional","affiliation":[{"name":"Sandra Lockmer, Bj\u00f6rn Engelbrekt Wahlin, Karin Ekstr\u00f6m Smedby, and Eva Kimby, Karolinska Institutet; Sandra Lockmer, Bj\u00f6rn Engelbrekt Wahlin, and Karin Ekstr\u00f6m Smedby, Karolinska University Hospital, Stockholm; Hans Hagberg, Academic Hospital, Uppsala; Ann-Sofie Johansson, Norrlands University Hospital, Ume\u00e5, Sweden; Bj\u00f8rn \u00d8stenstad and Harald Holte, Oslo University Hospital; Chlo\u00e9 Beate Steen, University of Oslo, Oslo; 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