Nirav N Shah1, Aniko Szabo2, Raya Saba3, Lauren Strelec4, Dheeraj Kodali5, John L Vaughn6, Olukemi Esan5, David T Yang7, Anthony R Mato4, Abraham S Kanate5, Horatiu Olteanu8, Mehdi Hamadani9, Timothy S Fenske10, Vaishalee P Kenkre11, Jakub Svoboda4, Amanda F Cashen3, Narendranath Epperla6. 1. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI. Electronic address: nishah@mcw.edu. 2. Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI. 3. Washington University School of Medicine, St Louis, MO. 4. University of Pennsylvania, Philadelphia, PA. 5. West Virginia University, Morgantown, WV. 6. Division of Hematology, The Ohio State University, Columbus, OH. 7. Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI. 8. Department of Pathology, Medical College of Wisconsin, Milwaukee, WI. 9. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI; Center of International Bone Marrow Transplant Research (CIBMTR), Milwaukee, WI. 10. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI. 11. Division of Hematology/Oncology, University of Wisconsin, Madison, WI.
Abstract
BACKGROUND: Follicular lymphoma (FL) is a common form of non-Hodgkin lymphoma with a wide spectrum of presentation. While grade 1/2 FL is considered low grade and grade 3B FL is approached as an aggressive lymphoma, the management of grade 3A FL remains controversial. PATIENTS AND METHODS: We performed a retrospective, multicenter analysis of patients aged ≥ 18 years with advanced stage 3/4 grade 3A FL diagnosed between January 2006 and July 2016. Patients were stratified by frontline chemotherapy regimen: anthracycline based (ATC), bendamustine (BD), and cyclophosphamide, vincristine, and prednisone (CVP). A total of 103 patients were identified from 6 contributing centers: 65 patients received ATC chemotherapy, 30 BD, and 8 CVP. The primary outcome was time to progression (TTP). Secondary outcomes included progression-free survival, overall survival, complete response rates, large cell transformation, and impact of standardized maximum uptake value on positron emission tomography/computed tomography with outcomes. Patient characteristics were similar among the 3 treatment groups. RESULTS: For TTP at 24 months from initiation of treatment, 72% of ATC, 79% of BD, and 50% of CVP patients had not experienced disease progression (P = .01). Multivariate analysis demonstrated a TTP benefit for ATC compared to CVP (hazard ratio 3.22; 95% confidence interval, 1.26-8.25; P = .01) but no difference when compared to BD. Similar findings were seen with progression-free survival. While overall survival was similar among the 3 arms, there was a higher risk of large cell transformation following BD and CVP. Last, standardized maximum uptake value on positron emission tomography/computed tomography did not affect TTP when comparing BD- and ATC-treated patients. CONCLUSION: Although ATC was superior to CVP, clinical outcomes (TTP, progression-free survival, and overall survival) were similar compared to BD chemotherapy for patients with grade 3A FL.
BACKGROUND:Follicular lymphoma (FL) is a common form of non-Hodgkin lymphoma with a wide spectrum of presentation. While grade 1/2 FL is considered low grade and grade 3B FL is approached as an aggressive lymphoma, the management of grade 3A FL remains controversial. PATIENTS AND METHODS: We performed a retrospective, multicenter analysis of patients aged ≥ 18 years with advanced stage 3/4 grade 3A FL diagnosed between January 2006 and July 2016. Patients were stratified by frontline chemotherapy regimen: anthracycline based (ATC), bendamustine (BD), and cyclophosphamide, vincristine, and prednisone (CVP). A total of 103 patients were identified from 6 contributing centers: 65 patients received ATC chemotherapy, 30 BD, and 8 CVP. The primary outcome was time to progression (TTP). Secondary outcomes included progression-free survival, overall survival, complete response rates, large cell transformation, and impact of standardized maximum uptake value on positron emission tomography/computed tomography with outcomes. Patient characteristics were similar among the 3 treatment groups. RESULTS: For TTP at 24 months from initiation of treatment, 72% of ATC, 79% of BD, and 50% of CVPpatients had not experienced disease progression (P = .01). Multivariate analysis demonstrated a TTP benefit for ATC compared to CVP (hazard ratio 3.22; 95% confidence interval, 1.26-8.25; P = .01) but no difference when compared to BD. Similar findings were seen with progression-free survival. While overall survival was similar among the 3 arms, there was a higher risk of large cell transformation following BD and CVP. Last, standardized maximum uptake value on positron emission tomography/computed tomography did not affect TTP when comparing BD- and ATC-treated patients. CONCLUSION: Although ATC was superior to CVP, clinical outcomes (TTP, progression-free survival, and overall survival) were similar compared to BD chemotherapy for patients with grade 3A FL.