Maintenance rituximab or observation after frontline treatment with bendamustine-rituximab for follicular lymphoma
Corresponding Author
Brian T. Hill
Cleveland Clinic, Cleveland, OH, USA
Correspondence: Brian T. Hill, Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, 9500 Euclid Ave. CA6, Cleveland, OH 44195, USA.
E-mail: [email protected]
Search for more papers by this authorLoretta Nastoupil
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorMelody R. Becnel
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorBrian K. Link
University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Search for more papers by this authorBita Fakhri
Washington University School of Medicine, Saint Louis, MO, USA
Search for more papers by this authorPrathima Reddy
Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
Search for more papers by this authorStephen D. Smith
Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
Search for more papers by this authorAmrita Desai
University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
Search for more papers by this authorJuan Pablo Alderuccio
University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
Search for more papers by this authorIzidore S. Lossos
University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
Search for more papers by this authorCraig A. Portell
University of Virginia, Charlottesville, VA, USA
Search for more papers by this authorMohammad J. Hussain
Levine Cancer Institute, Charlotte, NC, USA
Search for more papers by this authorPaolo Caimi
University Hospitals of Cleveland, Cleveland, OH, USA
Search for more papers by this authorTimothy Tiutan
Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA
Search for more papers by this authorPeter Martin
Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA
Search for more papers by this authorAbhigna Kodali
Tufts University School of Medicine and Cancer Center, Boston, MA, USA
Search for more papers by this authorAndrew M. Evens
Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
Search for more papers by this authorBrad S. Kahl
Washington University School of Medicine, Saint Louis, MO, USA
Search for more papers by this authorCorresponding Author
Brian T. Hill
Cleveland Clinic, Cleveland, OH, USA
Correspondence: Brian T. Hill, Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, 9500 Euclid Ave. CA6, Cleveland, OH 44195, USA.
E-mail: [email protected]
Search for more papers by this authorLoretta Nastoupil
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorMelody R. Becnel
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Search for more papers by this authorBrian K. Link
University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Search for more papers by this authorBita Fakhri
Washington University School of Medicine, Saint Louis, MO, USA
Search for more papers by this authorPrathima Reddy
Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
Search for more papers by this authorStephen D. Smith
Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
Search for more papers by this authorAmrita Desai
University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
Search for more papers by this authorJuan Pablo Alderuccio
University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
Search for more papers by this authorIzidore S. Lossos
University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
Search for more papers by this authorCraig A. Portell
University of Virginia, Charlottesville, VA, USA
Search for more papers by this authorMohammad J. Hussain
Levine Cancer Institute, Charlotte, NC, USA
Search for more papers by this authorPaolo Caimi
University Hospitals of Cleveland, Cleveland, OH, USA
Search for more papers by this authorTimothy Tiutan
Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA
Search for more papers by this authorPeter Martin
Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA
Search for more papers by this authorAbhigna Kodali
Tufts University School of Medicine and Cancer Center, Boston, MA, USA
Search for more papers by this authorAndrew M. Evens
Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
Search for more papers by this authorBrad S. Kahl
Washington University School of Medicine, Saint Louis, MO, USA
Search for more papers by this authorSummary
Bendamustine (B) with rituximab (R) is a standard frontline treatment for medically fit follicular lymphoma (FL) patients. The safety and efficacy of maintenance rituximab (MR) after BR induction has not been formally compared to observation for FL, resulting in disparate practice patterns. Prospective trials have shown benefit of MR after R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) or R-CVP (rituximab, cyclophosphamide, vincristine, prednisone), yet recent data from the GALLIUM study comparing outcomes of patients treated with chemotherapy with R or obinutuzumab (G) showed higher than anticipated fatal adverse events with BR/BG. In order to assess the efficacy and tolerability of MR after BR, we retrospectively collected data on 640 newly diagnosed patients treated with FL. We found that patients who achieved partial remission (PR) after ≥4 cycles of BR had improved duration of response (DOR) with MR vs. no maintenance, whereas those in complete remission did not. These findings were confirmed in a validation cohort. In the entire study population, the known fatal adverse event rate after BR was 2·5% and did not significantly differ in those receiving MR versus no maintenance. [Correction added on 14 January 2019, after online publication: The preceding sentence has been corrected in this current version.] Within the limitations inherent to retrospective analysis, these data suggest that FL patients with a PR to BR experience prolongation of remission with MR with an acceptable safety profile.
Supporting Information
| Filename | Description |
|---|---|
| bjh15720-sup-0001-FigS1.pdfPDF document, 50.3 KB | Fig S1. Clinical outcomes of entire patient population. |
| bjh15720-sup-0002-FigS2.pdfPDF document, 168.5 KB | Fig S2. Clinical outcomes of patient population based on FLIPI score and response to induction. |
| bjh15720-sup-0003-FigS3.pdfPDF document, 169.4 KB | Fig S3. Duration of response for patients in validation cohort. |
| bjh15720-sup-0004-FigS4.pdfPDF document, 138 KB | Fig S4. cumulative incidence of death based on rituximab maintenance. |
| bjh15720-sup-0005-TableS1-2.docxWord document, 22.5 KB |
Table SI. Baseline demographic and disease characteristics at diagnosis for 376 patients who received ≥4 cycles of BR and achieved CR or PR. Table SII. Baseline demographic and disease characteristics at diagnosis of patients in validation cohort from MD Anderson Cancer Center who achieved CR after ≥4 cycles of BR. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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