title: Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial.
abstract: We evaluated the role of rituximab (R) both in remission induction and maintenance treatment of relapsed/resistant follicular lymphoma (FL). A total of 465 patients were randomized to induction with 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) (every 3 weeks) or R-CHOP (R: 375 mg/m(2) intravenously, day 1). Those in complete remission (CR) or partial remission (PR) were randomized to maintenance with R (375 mg/m(2) intravenously once every 3 months for a maximum of 2 years) or observation. R-CHOP induction yielded an increased overall response rate (CHOP, 72.3%; R-CHOP, 85.1%; P < .001) and CR rate (CHOP, 15.6%; R-CHOP, 29.5%; P < .001). Median progression-free survival (PFS) from first randomization was 20.2 months after CHOP versus 33.1 months after R-CHOP (hazard ratio [HR], 0.65; P < .001). Rituximab maintenance yielded a median PFS from second randomization of 51.5 months versus 14.9 months with observation (HR, 0.40; P < .001). Improved PFS was found both after induction with CHOP (HR, 0.30; P < .001) and R-CHOP (HR, 0.54; P = .004). R maintenance also improved overall survival from second randomization: 85% at 3 years versus 77% with observation (HR, 0.52; P = .011). This is the first trial showing that in relapsed/resistant FL rituximab maintenance considerably improves PFS not only after CHOP but also after R-CHOP induction.
authors.affiliation: Department of Hematology F4-224, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. m.h.vanoers@amc.uva.nl
authors.forename: Marinus H J
authors.initials: MH
authors.lastname: van Oers
authors.forename: Richard
authors.initials: R
authors.lastname: Klasa
authors.forename: Robert E
authors.initials: RE
authors.lastname: Marcus
authors.forename: Max
authors.initials: M
authors.lastname: Wolf
authors.forename: Eva
authors.initials: E
authors.lastname: Kimby
authors.forename: Randy D
authors.initials: RD
authors.lastname: Gascoyne
authors.forename: Andrew
authors.initials: A
authors.lastname: Jack
authors.forename: Mars
authors.initials: M
authors.lastname: Van't Veer
authors.forename: Andrej
authors.initials: A
authors.lastname: Vranovsky
authors.forename: Harald
authors.initials: H
authors.lastname: Holte
authors.forename: Martine
authors.initials: M
authors.lastname: van Glabbeke
authors.forename: Ivana
authors.initials: I
authors.lastname: Teodorovic
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rozewicz
authors.forename: Anton
authors.initials: A
authors.lastname: Hagenbeek
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000633:toxicity; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012074:Remission Induction; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone