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The present letter is in relation to the article "Life expectancy of young adults with follicular lymphoma" published in the November 2015 Annals of Oncology. In agreement with this study, our group (The Spanish Lymphoma Oncology Group) analyzed the survival and clinicopathological characteristics of patients registered our national database of 1178 FL patients recruited between 1986 and 2012 and who were diagnosed prior to 40 years of age.

Relapse is the main cause of therapeutic failure in FL, which makes it necessary to investigate strategies that aim to eradicate minimal residual disease. This is why we set out to evaluate the role of consolidation with Y90-Ibritumomab Tiuxetan (RIT) in high-risk FL patients. As we possessed data making us suspect that prior treatment with Rituximab could reduce the efficacy of RIT, we designed a study with RIT after 4 cycles of CHOP-R and 2 CHOP, but without R. Material and Patients Between April 2008 and April 2010, 30 patients were included in this trial: 17 male (56.7%) and 13 female (43.3%). Their median age was 54.8 (range, 34-76). 20 (69%) patients had ECOG 0. There were no delays or reductions in RIT doses. Results The objective rate of clinical response was 92.1% (CR + CRi + PR), [CI 95%: 83-100%]. Of the 18 patients who presented with partial remission to the induction treatment, 11 (61.1%) had complete CR or remission after the consolidation treatment. There was only one exitus, due to H1N1 viral pneumonia. The most important G 3/4 toxicity was hematological, with 46% thrombopenia and 56% neutropenia. None of the patients in the trial died because of Lymphoma. With median follow-up of 26 months (12-37), the means for disease-free survival or overall survival were not reached. Conclusion The induction procedure with 4 CHOP-R + 2 CHOP prior to consolidation with RIT gives good response rates and RIT improves CR. This combination is safe and shows a high activity in both, induction and consolidation procedures. Disclosure All authors have declared no conflicts of interest.

e19502 Background: Rituximab maintenance have demonstrated improvements in progression-free and overall survival in relapsed patients with follicular lymphoma (FL). Ongoing trials are evaluating the benefit of rituximab maintenance following treatment of therapy-naive patients (pts) treated with rituximab-containing chemoinmunotherapy induction regimens. Methods: The current study evaluated the activity and toxicity of rituximab maintenance after chemoinmunotherapy in the first line treatment of advanced-stage FL. Pts with advanced stage FL were eligible. The induction treatment consisted in 8 courses of chemoinmunotherapy with R-CHOP (rituximab 375 mg/m2; cyclophosphamide 750 mg/m2; doxorubicin 50 mg/m2 and vincristine 2 mg). Pts entering a complete (CR) or partial remission (PR) received maintenance with 6 doses of rituximab (375 mg/m2/d) to be given every two months after the end of induction therapy. Results: From December 2004 to November 2006, 52 pts were included. Median age was 52 years (range, 36–85) and 26 pts were women. At baseline 32 (62%) pts had stage IV and 20 (38%) stage III. According to the Follicular Lymphoma International Prognostic Index (FLIPI), 8 pts (15%) had low risk disease, 24 pts (46%) intermediate risk, and 20 pts (39%) high risk disease. Six (12%) pts did not receive maintenance (3 pts progressed during induction, 2 pts refused maintenance and 1 pt had severe toxicity to induction). Of the 46 pts included in the maintenance phase, 32 (69%) were in CR/CRu and 14 pts (31%) in PR after induction therapy. Rituximab was well tolerated in the maintenance phase. Only 5 pts didn´t receive the 6 scheduled courses (toxicity: 1; progressive disease: 2; cardiovascular events: 2). Grade 3–4 toxicity occurred as follow: neutropenia in 4 pts (9%), and fever in 1 pt (2%). No severe infections were seen. After maintenance, 40 (87%) pts were in CR/CRu, 4 pts (9%) in PR and 2 (4%) progressed. With a median follow-up of 27 months, progression-free and overall survival at 30 months were 82% and 92%, respectively. Conclusions: Rituximab maintenance after first-line R-CHOP is safe and increase the complete remission rate obtained in the induction phase. No significant financial relationships to disclose.

Hodgkin lymphoma (HL) is an uncommon B cell lymphoid malignancy representing approximately 10–15 % of all lymphomas. HL is composed of two distinct disease entities; the more commonly diagnosed classical HL and the rare nodular lymphocyte-predominant HL. An accurate assessment of the stage of disease and prognostic factors that identify patients at low or high risk for recurrence are used to optimize therapy. Patients with early stage disease are treated with combined modality strategies using abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced stage disease receive a longer course of chemotherapy often without radiation therapy. High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. Brentuximab vedotin should be considered for patients who fail HDCT with ASCT.

Follicular non-Hodgkin's lymphoma (FL) is a nodal B lymphoid malignancy that originates from the germinal center of a lymph node. FL is the second most frequent lymphoma subtype. The course of the disease is usually characterised by a typically indolent clinical course, with a median survival rate of 8-10 years, although most patients relapse after treatment. Diagnosis should always be based on a surgical specimen like an excisional node lymph biopsy. The first-line treatment of FL will depend of extension disease, tumour burden, patient symptoms, performance status and also patient decision. The addition of rituximab to conventional chemotherapy has improved ORR, PFS and OS. As first line in patients that need treatment, a combination of chemotherapy with rituximab induction followed by 2 years of rituximab maintenance is the best option. High-dose chemotherapy with autologous stem-cell transplantation in first line has not shown improvement and is not recommended as first-line therapy. Before any treatment decision in relapsed patients, a repeat biopsy is mandatory to rule out a transformation into large cell aggressive lymphoma. Standard treatment is controversial, depends on the efficacy of prior treatment, duration of the time-to-relapse, patient's age and histological findings at relapse.