Dr Kahl confesses that clinical decision-making is particularly challenging for Grade 3A disease, but he, Dr Williams and a majority of the MO surveyed use R-CHOP. Dr Williams points out that several major clinical studies suggest the possibility of a “tail on the curve” in this subset and that perhaps 40% or so of patients receiving R-CHOP may indeed have durable responses and might even be “cured” akin to what is observed in diffuse large B-cell lymphoma.

Ardeshna KM et al. Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lymphoma: An open-label randomised phase 3 trial. Lancet Oncol 2014;15(4):424-35. Abstract

Rummel MJ et al. Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: An open-label, multicentre, randomised, phase 3 non-inferiority trial. Lancet 2013;381(9873):1203-10. Abstract

Salles GA et al. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): A phase 3, randomised controlled trial. Lancet 2011;377(9759):42-51. Abstract