Marco Ruella1, Andrea Riccardo Filippi2, Riccardo Bruna3, Anna Di Russo4, Michele Magni5, Daniele Caracciolo6, Roberto Passera7, Paola Matteucci5, Massimo Di Nicola5, Paolo Corradini8, Guido Parvis9, Guido Gini10, Attilio Olivieri10, Marco Ladetto6, Umberto Ricardi2, Corrado Tarella11, Liliana Devizzi5. 1. Division of Haematology and Cell Therapy, Mauriziano Hospital and University of Torino, Torino, Italy; Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 2. Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy. 3. Division of Haematology and Cell Therapy, Mauriziano Hospital and University of Torino, Torino, Italy. 4. Radiation Oncology, Istituto Nazionale Tumori, Milano, Italy. 5. Division of Medical Oncology, Istituto Nazionale Tumori, and University of Milano, Milano, Italy. 6. Division of Haematology, San Giovanni Battista Hospital and University of Torino, Torino, Italy. 7. Division of Nuclear Medicine, San Giovanni Battista Hospital and University of Torino, Torino, Italy. 8. Division of Haematology, Istituto Nazionale Tumori, and University of Milano, Milano, Italy. 9. Division of Haematology, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy. 10. Division of Haematology, Ospedali Riuniti, Ancona, Italy. 11. Division of Haematology and Cell Therapy, Mauriziano Hospital and University of Torino, Torino, Italy; Hemato-Oncology Division, European Institute of Oncology, Milano, Italy. Electronic address: corrado.tarella@gmail.com.
Abstract
PURPOSE: Rituximab (Rit) therapy added to involved-field radiation therapy (RT) has been proposed as an effective treatment for stage I-II follicular lymphoma (FL). The results of an observational multicenter study on the Rit-RT combination in limited-stage FL are here reported. METHODS AND MATERIALS: Data have been collected from 2 consecutive cohorts of 94 patients with stage I-II FL treated between 1985 and 2011 at 5 Italian institutions. All patients had grade 1-3a FL, a median age of 54 years (range: 25-82). The first 51 patients received RT alone (control group), while the subsequent series of 43 patients received 4 rituximab courses (375 mg/m(2), days 1, 8, 15, 22) before RT (Rit-RT). Molecular disease was evaluated by nested bcl-2/IgH PCR or clonal IgH rearrangement was available in 33 Rit-RT patients. RESULTS: At a median follow-up of 10.9 years (range: 1.8-22.9), the 10-year progression-free survival (PFS) and overall survival (OS) projections for the whole cohort were 57% and 87.5%, respectively. The 10-year PFS was significantly longer (P<.05) in the Rit-RT group (64.6%) compared to RT alone (50.7%), whereas the 10-year OS projections were not significantly different. On bivariate analysis controlling for stage, there was only a trend toward improved PFS for Rit-RT (HR, 0.55; P=.081). Follicular lymphoma international prognostic index and age were associated with OS but not with PFS on Cox regression analysis. Bone marrow molecular analysis showing PCR positivity at diagnosis was strongly associated with relapse risk upon univariate and multivariate analysis. CONCLUSIONS: This multicenter observational study suggests a potential benefit of adding rituximab to radiation therapy for stage I-II FL. The results of the currently ongoing randomized studies are required to confirm these results. The study underlines the importance of molecular disease monitoring also for patient with limited-stage disease.
PURPOSE:Rituximab (Rit) therapy added to involved-field radiation therapy (RT) has been proposed as an effective treatment for stage I-II follicular lymphoma (FL). The results of an observational multicenter study on the Rit-RT combination in limited-stage FL are here reported. METHODS AND MATERIALS: Data have been collected from 2 consecutive cohorts of 94 patients with stage I-II FL treated between 1985 and 2011 at 5 Italian institutions. All patients had grade 1-3a FL, a median age of 54 years (range: 25-82). The first 51 patients received RT alone (control group), while the subsequent series of 43 patients received 4 rituximab courses (375 mg/m(2), days 1, 8, 15, 22) before RT (Rit-RT). Molecular disease was evaluated by nested bcl-2/IgH PCR or clonal IgH rearrangement was available in 33 Rit-RT patients. RESULTS: At a median follow-up of 10.9 years (range: 1.8-22.9), the 10-year progression-free survival (PFS) and overall survival (OS) projections for the whole cohort were 57% and 87.5%, respectively. The 10-year PFS was significantly longer (P<.05) in the Rit-RT group (64.6%) compared to RT alone (50.7%), whereas the 10-year OS projections were not significantly different. On bivariate analysis controlling for stage, there was only a trend toward improved PFS for Rit-RT (HR, 0.55; P=.081). Follicular lymphoma international prognostic index and age were associated with OS but not with PFS on Cox regression analysis. Bone marrow molecular analysis showing PCR positivity at diagnosis was strongly associated with relapse risk upon univariate and multivariate analysis. CONCLUSIONS: This multicenter observational study suggests a potential benefit of adding rituximab to radiation therapy for stage I-II FL. The results of the currently ongoing randomized studies are required to confirm these results. The study underlines the importance of molecular disease monitoring also for patient with limited-stage disease.
Authors: Klaus Herfarth; Peter Borchmann; Sven Schnaidt; Karin Hohloch; Volker Budach; Marianne Engelhard; Andreas Viardot; Rita Engenhart-Cabillic; Ulrich Keller; Gabriele Reinartz; Hans-Theodor Eich; Mathias Witzens-Harig; Clemens F Hess; Bernd Dörken; Jan Dürig; Thomas Wiegel; Wolfgang Hiddemann; Eva Hoster; Christiane Pott; Martin Dreyling Journal: Hemasphere Date: 2018-11-30
Authors: Melissa Lumish; Lorenzo Falchi; Brandon S Imber; Michael Scordo; Gottfried von Keudell; Erel Joffe Journal: J Hematol Oncol Date: 2021-01-06 Impact factor: 17.388