title: The role of anthracyclines in combination chemotherapy for the treatment of follicular lymphoma: retrospective study of the Intergruppo Italiano Linfomi on 761 cases.
abstract: In order to elucidate the role of anthracycline based combination chemotherapy regimens for the treatment of follicular lymphoma we conducted a retrospective study on a large series of patients with a histologically confirmed diagnosis of follicular lymphoma. The Italian lymphoma intergroup (ILI) promoted a retrospective study of patients with follicular lymphoma treated in cooperative trials between 1985 and 1996. Six hundred and thirty three cases were treated with an anthracycline-containing regimen and 128 patients were treated without anthracyclines. The two groups were prognostically comparable; in particular, no difference was observed according to both IPI and ILI prognostic index. Results showed a complete remission (CR) rate for patients treated with anthracyclines was 69.2% and overall response rate was 92.5%. After a median follow-up of 51 months (54 months for patients still alive), the 5- and 10-year overall survival (OS) rates were 80 and 66%, respectively. Disease-free survival (DFS) and failure-free survival (FFS) rates at 5 years were 61 and 49%, respectively. In the group of patients treated with combination chemotherapy not including anthracyclines, the CR rate was 67.5% and the overall response rate was 85.4%. A longer OS (80% at 5 years) was observed in patients treated with anthracyclines compared to 67% OS rate in patients treated without anthracyclines (p = 0.0004). FFS was significantly longer in patients treated with anthracyclines (49 vs. 34% p = 0.006). Patients treated with anthracyclines with low or intermediate risk according to ILI prognostic index showed a significantly longer OS (p = 0.0001 andp = 0.0009, respectively); those in the high-risk group showed a trend for a longer survival. In conclusion, this retrospective study shows that patients with follicular lymphoma treated with an anthracycline containing regimen had a better outcome compared to patients treated with other combination regimens non including anthracyclines in terms of CRs, OS and FFS. On the basis of these results anthracycline-containing regimens (ACR) should be considered as the standard treatment of patients with advanced follicular lymphoma.
authors.affiliation: Cattedra e Divisione di Ematologia, Università di Firenze, Firenze, Italia. l.rigacci@dfc.unifi.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Rigacci
authors.forename: Massimo
authors.initials: M
authors.lastname: Federico
authors.forename: Maurizio
authors.initials: M
authors.lastname: Martelli
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Zinzani
authors.forename: Luigi
authors.initials: L
authors.lastname: Cavanna
authors.forename: Giampiero
authors.initials: G
authors.lastname: Bellesi
authors.forename: Francesco
authors.initials: F
authors.lastname: Merli
authors.forename: Renato
authors.initials: R
authors.lastname: Alterini
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Petrucci
authors.forename: Monica
authors.initials: M
authors.lastname: Tani
authors.forename: Anna Marina
authors.initials: AM
authors.lastname: Liberati
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pavone
authors.forename: Antonio
authors.initials: A
authors.lastname: Cuneo
authors.forename: Teodoro
authors.initials: T
authors.lastname: Chisesib
authors.forename: Maura
authors.initials: M
authors.lastname: Brugiatelli
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007558:Italy; D008224:Lymphoma, Follicular / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic