Factors influencing outcome in advanced stage, low-grade follicular lymphoma treated at MD Anderson Cancer Center in the rituximab era

Chan Cheah, D. Chihara, M. Ahmed, R.E. Davis, L.J. Nastoupil, K. Phansalkar, F.B. Hagemeister, L.E. Fayad, J.R. Westin, Y. Oki, M.A. Fanale, J.E. Romaguera, M.L. Wang, H. Lee, F. Turturro, F. Samaniego, M.A. Rodriguez, S.S. Neelapu, N.H. Fowler

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    © 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
    Original languageEnglish
    Article numbermdw014
    Pages (from-to)895-901
    Number of pages7
    JournalAnnals of Oncology
    Issue number5
    Publication statusPublished - 1 May 2016


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