Beginning chemotherapy only after symptoms develop may benefit patients diagnosed with asymptomatic, advanced low-grade non-Hodgkin lymphoma, according to an article in the July 16th issue of the Lancet.

Chemotherapy (single agent or aggressive combination therapy) is not curative for advanced-stage, low-grade non-Hodgkin lymphomas, even when combined with radiotherapy. In the current study, Kirit Ardeshna, MD, and her British colleagues compared immediate use of chlorambucil with a strategy of initiating chemotherapy after clinical progression necessitated its use in patients whose disease was asymptomatic when diagnosed.

A total of 309 patients were recruited between 1981 and 1990. Half of the patients were randomized to immediate chemotherapy with oral chlorambucil (10 mg per day); the other half was randomized to a policy of 'wait and see', with chemotherapy delayed until disease progressed clinically. Local radiotherapy was given to both groups if lymph nodes showed evidence of disease.

The average follow-up of patients was 16 years: Patients in the 'wait and see' group required chemotherapy after an average of 2.5 years. There was no difference in overall survival (around 6 years) or in disease-specific survival (around 9 years) between the groups. People in the 'wait and see' group had roughly a 20 percent chance of not requiring chemotherapy for at least 10 years; Likelihood was doubled to 40 percent when patients were over 70 years of age at time of diagnosis.
Ardeshna concluded, "An initial policy of watchful waiting in patients with asymptomatic, advanced stage low-grade non-Hodgkin lymphoma is appropriate, especially in patients aged over 70 years."