C Y Cheah1, D Chihara2, M Ahmed2, R E Davis2, L J Nastoupil2, K Phansalkar2, F B Hagemeister2, L E Fayad2, J R Westin2, Y Oki2, M A Fanale2, J E Romaguera2, M L Wang2, H Lee2, F Turturro2, F Samaniego2, M A Rodriguez2, S S Neelapu2, N H Fowler3. 1. Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine, Perth School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia. 2. Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA. 3. Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA nfowler@mdanderson.org.
Abstract
BACKGROUND: The optimal initial therapy of follicular lymphoma (FL) remains unclear. The aims of this study were to compare primary treatment strategies and assess the impact of maintenance rituximab and patterns of treatment failure. PATIENTS AND METHODS: We retrospectively analyzed patients with treatment-naive advanced stage, grade 1-2 FL treated at our center from 2004 to 2014. We included 356 patients treated on clinical trials or standard of care with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP, n = 119); R-CHOP with maintenance (R-CHOP + M, n = 65); bendamustine/rituximab (BR, n = 45); BR with maintenance (BR + M, n = 35); R(2) (n = 94). We compared baseline characteristics, progression-free survival (PFS), overall survival (OS) and analyzed prognostic factors using univariate and multivariate analysis adjusted for treatment. RESULTS: After a median follow-up of 4 years (range 0.2-15.0), the 3-year PFS was 60% [95% confidence interval (CI) 51% to 69%] for R-CHOP, 72% (59% to 82%) for R-CHOP + M, 63% (42% to 78%) for BR, 97% (80% to 100%) for BR + M and 87% (78% to 93%) for R(2). Patients treated with R-chemotherapy had more high-risk features than patients treated with R(2) but, by adjusted multivariate analysis, treatment with R(2) [hazard ratio (HR) 0.39 (0.17-0.89), P = 0.02] was associated with a superior PFS. Eastern Cooperative Oncology Group Performance status of one or more predicted inferior OS. Among patients treated with R-chemotherapy, maintenance was associated with the superior PFS [HR 0.38 (95% CI 0.21-0.68)]. By adjusted multivariate analysis, disease progression within 2 years [HR 5.1 (95% CI 1.57-16.83)] and histologic transformation (HT) [HR 11.05 (95% CI 2.84-42.93)] increased risk of death. CONCLUSION: Induction therapy with R(2) may result in disease control which is comparable with R-chemotherapy. Early disease progression and HT are predictive of inferior survival.
BACKGROUND: The optimal initial therapy of follicular lymphoma (FL) remains unclear. The aims of this study were to compare primary treatment strategies and assess the impact of maintenance rituximab and patterns of treatment failure. PATIENTS AND METHODS: We retrospectively analyzed patients with treatment-naive advanced stage, grade 1-2 FL treated at our center from 2004 to 2014. We included 356 patients treated on clinical trials or standard of care with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP, n = 119); R-CHOP with maintenance (R-CHOP + M, n = 65); bendamustine/rituximab (BR, n = 45); BR with maintenance (BR + M, n = 35); R(2) (n = 94). We compared baseline characteristics, progression-free survival (PFS), overall survival (OS) and analyzed prognostic factors using univariate and multivariate analysis adjusted for treatment. RESULTS: After a median follow-up of 4 years (range 0.2-15.0), the 3-year PFS was 60% [95% confidence interval (CI) 51% to 69%] for R-CHOP, 72% (59% to 82%) for R-CHOP + M, 63% (42% to 78%) for BR, 97% (80% to 100%) for BR + M and 87% (78% to 93%) for R(2). Patients treated with R-chemotherapy had more high-risk features than patients treated with R(2) but, by adjusted multivariate analysis, treatment with R(2) [hazard ratio (HR) 0.39 (0.17-0.89), P = 0.02] was associated with a superior PFS. Eastern Cooperative Oncology Group Performance status of one or more predicted inferior OS. Among patients treated with R-chemotherapy, maintenance was associated with the superior PFS [HR 0.38 (95% CI 0.21-0.68)]. By adjusted multivariate analysis, disease progression within 2 years [HR 5.1 (95% CI 1.57-16.83)] and histologic transformation (HT) [HR 11.05 (95% CI 2.84-42.93)] increased risk of death. CONCLUSION: Induction therapy with R(2) may result in disease control which is comparable with R-chemotherapy. Early disease progression and HT are predictive of inferior survival.
Authors: Connie L Batlevi; Fushen Sha; Anna Alperovich; Ai Ni; Katy Smith; Zhitao Ying; John F Gerecitano; Paul A Hamlin; Steve M Horwitz; Erel Joffe; Anita Kumar; Matthew J Matasar; Alison J Moskowitz; Craig H Moskowitz; Ariela Noy; Colette Owens; Lia M Palomba; David Straus; Gottfried von Keudell; Andrew D Zelenetz; Venkatraman E Seshan; Stefano Luminari; Luigi Marcheselli; Massimo Federico; Anas Younes Journal: Eur J Cancer Date: 2020-01-08 Impact factor: 9.162
Authors: C Madsen; M R Clausen; T L Plesner; A Pasanen; T Kuismanen; H H Bentzen; J M Jørgensen; I B Sillesen; B M Himmelstrup; D Rønnov-Jessen; K R Jensen; A M Pettinger; M Ludvigsen; S Leppä; F A d'Amore Journal: Blood Adv Date: 2018-07-10
Authors: Franck Morschhauser; Nilanjan Ghosh; Izidore S Lossos; M Lia Palomba; Amitkumar Mehta; Olivier Casasnovas; Don Stevens; Sudhakar Katakam; Andrea Knapp; Tina Nielsen; Ron McCord; Gilles Salles Journal: Blood Cancer J Date: 2021-08-20 Impact factor: 11.037
Authors: Nahikari Bartolomé-Izquierdo; Virginia G de Yébenes; Angel F Álvarez-Prado; Sonia M Mur; Juan A Lopez Del Olmo; Sergio Roa; Jesus Vazquez; Almudena R Ramiro Journal: Blood Date: 2017-02-10 Impact factor: 22.113