Bendamustine plus Rituximab Versus R-CHOP as First-Line Treatment for Patients with Follicular Lymphoma Grade 3A: Evidence from a Multicenter, Retrospective Study
Bendamustine plus Rituximab Versus R-CHOP as First-Line Treatment for Patients with Follicular Lymphoma Grade 3A: Evidence from a Multicenter, Retrospective Study
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DOI：
10.1634/theoncologist.2017-0037
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发表时间：
2018-04-01
期刊：
影响因子：
5.8
通讯作者：
Mian, Michael
中科院分区：
文献类型：
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作者：
Mondello, Patrizia;Steiner, Normann;Mian, Michael
背景资料。与利妥昔单抗、环磷酰胺、阿霉素和强的松(R-CHOP)相比，利妥昔单抗联合苯达莫司汀(R-B)可改善滤泡性淋巴瘤(FL)的疗效并降低毒性。然而，在临床实践中，许多中心仍然偏爱3A级FL患者的R-CHOP而不是R-B。因此，我们在五个欧洲癌症中心对接受R-CHOP或R-B治疗的FL3A患者进行了回顾性评估，并比较了他们的结果。我们对132例FL分级为3A的患者进行了一线的R-B或R-CHOP治疗，并根据治疗类型评估了结果和毒性。这项研究包括101名患者，他们是先前发表的队列的子组。与R-CHOP相比，R-B毒性较小，完全缓解率相似(97%比96%，p=0.3)。在随访期间，10名患者(16%)在R-B后复发，29名(41%)患者在R-CHOP后复发(p=.001)，导致中位无进展生存期(PFS)分别为15年和11.7年(p=.03)。此外，R-B克服了bcl2表达对预后的负面影响(15年对4.8年；p=.001)。然而，两组患者的中位总存活率相似(两组均未达到；p=0.8)。作为治疗FL3A的一线治疗，R-B比R-CHOP耐受性更好，似乎能引起更深刻的反应，导致显著降低复发率和延长PFS。因此，R-B是治疗FL 3A级的有效方法。
Background. Rituximab plus bendamustine (R-B) has been demonstrated to improve outcomes and reduce toxicity compared with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) in follicular lymphoma (FL). Nevertheless, in clinical practice, many centers still prefer R-CHOP to R-B in patients with FL grade 3A (FL3A). Therefore, we retrospectively assessed patients with FL3A treated with either R-CHOP or R-B in five European cancer centers and compared their outcomes.Materials and Methods. We retrospectively assessed 132 patients affected by FL grade 3A treated with either R-B or R-CHOP in the first line and evaluated outcome and toxicity according to the type of treatment. This study included 101 patients who were a subgroup of a previously published cohort.Results. R-B was less toxic and achieved a similar percentage of complete remissions compared with R-CHOP (97% vs. 96%, p = .3). During follow-up, 10 (16%) patients relapsed after R-B and 29 (41%) after R-CHOP (p = .001), leading to a median progression-free survival (PFS) of 15 versus 11.7 years, respectively (p = .03). Furthermore, R-B overcame the negative prognostic impact of BCL2 expression (15 vs. 4.8 years; p = .001). However, median overall survival was similar between both groups (not reached for both; p = .8).Conclusion. R-B as a first-line treatment of FL3A is better tolerated than R-CHOP and seems to induce more profound responses, leading to a significantly lower relapse rate and prolonged PFS. Therefore, R-B is a valid treatment option for FL grade 3A.