title: Phase II trial of short-course CHOP-R followed by 90Y-ibritumomab tiuxetan and extended rituximab in previously untreated follicular lymphoma.
abstract: OBJECTIVE
  Radioimmunotherapy has been approved for relapsed follicular lymphoma (FL), including rituximab-refractory FL. This study was designed to determine the CR rate with short-course chemoimmunotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab (CHOP-R) followed by 90-Y ibritumomab tiuxetan (RIT) with extended rituximab as first-line treatment.
  
  
  METHODS
  Between March 2004 and February 2007, 60 patients with stage II to IV symptomatic or bulky FL from a single institution supported by a large community network entered this phase II trial. Patients received CHOP-R for three treatment cycles before RIT followed by four additional weekly treatments with rituximab. Response was determined using fusion [(18) F] fluorodeoxyglucose-positron emission tomography (PET)-computed tomography (CT) imaging.
  
  
  RESULTS
  Of the 60 patients entering this trial, 55 patients completed all protocol therapy. The median follow up was 19.7 months (range, 0.26-35.9 months). For intent-to-treat analysis, the complete response (CR) rate after CHOP-R, as assessed by CT and PET imaging, was 40% and 46%, respectively. After RIT, the CR rate improved, as assessed by CT and PET imaging, to 82% and 89%, respectively. Ten patients have progressed, including eight from best response of CR. Seven of 18 patients who were PET positive after CHOP-R progressed compared with 3 of 37 patients who were PET negative (P=0.010).
  
  
  CONCLUSIONS
  In patients with previously untreated, symptomatic or bulky FL, short-course chemoimmunotherapy and consolidation RIT and extended rituximab resulted in a high CR rate. Failure to achieve an early PET CR after CHOP-R indicated high risk of relapse.
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center Cancer Centers, Pittsburgh, Pennsylvania 15232, USA. jacobssa@upmc.edu
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Jacobs
authors.forename: Steven H
authors.initials: SH
authors.lastname: Swerdlow
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kant
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Foon
authors.forename: Rachel
authors.initials: R
authors.lastname: Jankowitz
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Land
authors.forename: Nicholas
authors.initials: N
authors.lastname: DeMonaco
authors.forename: Judith
authors.initials: J
authors.lastname: Joyce
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Osborn
authors.forename: Terry L
authors.initials: TL
authors.lastname: Evans
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Schaefer
authors.forename: The Minh
authors.initials: TM
authors.lastname: Luong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; C422802:ibritumomab tiuxetan