TY - JOUR
T1 - Factors influencing outcome in advanced stage, low-grade follicular lymphoma treated at MD Anderson Cancer Center in the rituximab era
AU - Cheah, Chan
AU - Chihara, D.
AU - Ahmed, M.
AU - Davis, R.E.
AU - Nastoupil, L.J.
AU - Phansalkar, K.
AU - Hagemeister, F.B.
AU - Fayad, L.E.
AU - Westin, J.R.
AU - Oki, Y.
AU - Fanale, M.A.
AU - Romaguera, J.E.
AU - Wang, M.L.
AU - Lee, H.
AU - Turturro, F.
AU - Samaniego, F.
AU - Rodriguez, M.A.
AU - Neelapu, S.S.
AU - Fowler, N.H.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. 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); R2 (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 R2. Patients treated with R-chemotherapy had more high-risk features than patients treated with R2 but, by adjusted multivariate analysis, treatment with R2 [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 R2 may result in disease control which is comparable with R-chemotherapy. Early disease progression and HT are predictive of inferio
AB - © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. 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); R2 (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 R2. Patients treated with R-chemotherapy had more high-risk features than patients treated with R2 but, by adjusted multivariate analysis, treatment with R2 [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 R2 may result in disease control which is comparable with R-chemotherapy. Early disease progression and HT are predictive of inferio
U2 - 10.1093/annonc/mdw026
DO - 10.1093/annonc/mdw026
M3 - Article
C2 - 26802151
SN - 0923-7534
VL - 27
SP - 895
EP - 901
JO - Annals of Oncology
JF - Annals of Oncology
IS - 5
M1 - mdw014
ER -
