title: Monitoring of minimal residual disease after CHOP and rituximab in previously untreated patients with follicular lymphoma.
abstract: Minimal residual disease (MRD) following sequential administration of CHOP and rituximab was studied in previously untreated patients with follicular lymphoma. At diagnosis, the presence of Bcl-2/IgH-positive cells in the peripheral blood (PB) and/or bone marrow (BM) was demonstrated in all patients (n = 128) by polymerase chain reaction (PCR) analysis. Patients who achieved a clinical response following CHOP but remained PCR-positive were eligible for rituximab (375 mg/m(2) intravenously, weekly for 4 weeks). After CHOP, 57% achieved a complete response (CR), 37% a partial response (PR), and 6% were nonresponders (NR). At this stage, patients proving PCR-negative (n = 41) or failing to achieve a clinical response (n = 8) were excluded from rituximab treatment. Seventy-seven patients received rituximab and entered a scheduled MRD follow-up program. At the first molecular follow-up (+12 weeks), 59% had converted to PCR negativity in the BM and PB, with a further increase documented at the second control (+28 weeks) with 74% PCR negative. At the last molecular follow-up (+44 weeks), 63% of the patients remained PCR negative. At 3 years, the estimated overall survival of all patients is 95% (95% confidence interval [CI], 86-98). For patients achieving PCR-negative status following CHOP and therefore excluded from rituximab treatment, freedom from recurrence (FFR) was 52% (95% CI, 28-71). For patients treated with rituximab, a durable PCR-negative status was associated with a better clinical outcome since FFR was 57% (95% CI, 23-81) compared with 20% (95% CI, 4-46) in patients who never achieved or lost the molecular negativity (P <.001).
authors.affiliation: Divisione di Ematologia, Ospedali Riuniti Bergamo, Largo Barozzi 1, 24100 Bergamo, Italy. arambaldfi@ospedaliriuniti.bergamo.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Manuela
authors.initials: M
authors.lastname: Lazzari
authors.forename: Cristina
authors.initials: C
authors.lastname: Manzoni
authors.forename: Emanuela
authors.initials: E
authors.lastname: Carlotti
authors.forename: Luca
authors.initials: L
authors.lastname: Arcaini
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Tiziano
authors.initials: T
authors.lastname: Barbui
authors.forename: Carlo
authors.initials: C
authors.lastname: Bernasconi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Dastoli
authors.forename: Giovanna
authors.initials: G
authors.lastname: Fuga
authors.forename: Enrica
authors.initials: E
authors.lastname: Gamba
authors.forename: Livio
authors.initials: L
authors.lastname: Gargantini
authors.forename: Valter
authors.initials: V
authors.lastname: Gattei
authors.forename: Francesco
authors.initials: F
authors.lastname: Lauria
authors.forename: Mario
authors.initials: M
authors.lastname: Lazzarino
authors.forename: Franco
authors.initials: F
authors.lastname: Mandelli
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pulsoni
authors.forename: Michela
authors.initials: M
authors.lastname: Ribersani
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Rossi-Ferrini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rupolo
authors.forename: Sante
authors.initials: S
authors.lastname: Tura
authors.forename: Vittorina
authors.initials: V
authors.lastname: Zagonel
authors.forename: Francesco
authors.initials: F
authors.lastname: Zaja
authors.forename: PierLuigi
authors.initials: P
authors.lastname: Zinzani
authors.forename: Gigliola
authors.initials: G
authors.lastname: Reato
authors.forename: Robin
authors.initials: R
authors.lastname: Foa
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000633:toxicity; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001773:Blood Cells; D001853:Bone Marrow; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005803:Genes, Immunoglobulin; D019254:Genes, bcl-2; D006801:Humans; D008224:Lymphoma, Follicular / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000188:drug therapy; D016133:Polymerase Chain Reaction; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D000069283:Rituximab; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone