Immediate treatment for asymptomatic, low-tumor burden follicular lymphoma (FL) has not shown an overall survival benefit over “watch and wait” (W/W) strategy. We estimated incidence of treatment initiation at specific time points and assessed its association with the presence of any criteria such as GELF, BNLI, GITMO at diagnosis. FL patients managed by W/W strategy were identified from the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma SPORE between 2002 and 2015. Cumulative incidence estimates of treatment initiation were calculated using transformation (as the first event) and death as competing risks. 401 FL patients were identified on W/W strategy. At a median follow-up of 8 years, 256 (64%) initiated treatment. For patients on the W/W strategy for 5 years, the likelihood of treatment initiation in the next 5 years was 12% compared to 43% at diagnosis unlike transformation rates which remained steady. Patients with any of popular treatment criteria at diagnosis did not have increased therapy initiation rates (44% vs. 42%) during the first 5 years or lymphoma-related death rates at 10 years (6% vs. 7%). Identifying biological differences in patients with early vs. late or no progression is a critical next step in understanding outcomes in W/W patients.

对无症状、低肿瘤负荷滤泡性淋巴瘤 (FL) 的即时治疗并未显示出优于“观察和等待” (W/W) 策略的总体生存获益。我们估计了在特定时间点开始治疗的发生率，并评估了其与诊断时是否存在任何标准（如 GELF、BNLI、GITMO）的关联。在 2002 年至 2015 年间，通过 W/W 策略管理的 FL 患者从爱荷华大学/梅奥诊所淋巴瘤 SPORE 的分子流行病学资源 (MER) 中确定。治疗开始的累积发病率估计值使用转化（作为第一个事件）和死亡作为竞争风险。W/W 策略确定了 401 名 FL 患者。中位随访 8 年，256 人（64%）开始治疗。对于使用 W/W 策略 5 年的患者，未来 5 年内开始治疗的可能性为 12%，而诊断时为 43%，这与保持稳定的转化率不同。在诊断时符合任何流行治疗标准的患者在前 5 年的治疗开始率（44% 对 42%）或 10 年的淋巴瘤相关死亡率（6% 对 7%）没有增加。识别早期与晚期或无进展患者的生物学差异是了解 W/W 患者预后的关键下一步。