title: Comparison of the effectiveness of frontline chemoimmunotherapy regimens for follicular lymphoma used in the United States.
abstract: To compare the effectiveness of frontline rituximab-chemotherapy regimens in clinical practice, we examined outcomes for patients with low-grade, stage III/IV follicular lymphoma receiving rituximab (R) with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), R with cyclophosphamide, vincristine and prednisone (R-CVP) or R with a fludarabine-based regimen (R-Flu) as frontline therapy. In total, 611 patients meeting these criteria were identified in the National LymphoCare Study: 47% receiving R-CHOP (n = 287), 31% receiving R-CVP (n = 187) and 22% receiving R-Flu (n = 137). Overall response rates were high (R-CVP 87%, R-CHOP 93%, R-Flu 94%; p = 0.017). Median follow-up was 7.4 years. R-CVP was associated with lower 5-year overall survival (R-CVP 76%, R-CHOP 86%, R-Flu 86%; p = 0.021) and progression-free survival (R-CVP 49%, R-CHOP 58%, R-Flu 64%; p = 0.029). There were no significant differences in survival in Cox models adjusted for baseline clinical factors, practice region/setting and post-treatment R maintenance/observation.
authors.affiliation: The University of Texas M. D. Anderson Cancer Center , Houston, TX , USA.
authors.forename: Loretta J
authors.initials: LJ
authors.lastname: Nastoupil
authors.forename: Rajni
authors.initials: R
authors.lastname: Sinha
authors.forename: Michelle
authors.initials: M
authors.lastname: Byrtek
authors.forename: Ryan
authors.initials: R
authors.lastname: Ziemiecki
authors.forename: Michael
authors.initials: M
authors.lastname: Taylor
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.forename: Jean L
authors.initials: JL
authors.lastname: Koff
authors.forename: Brian K
authors.initials: BK
authors.lastname: Link
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
authors.forename: Keith L
authors.initials: KL
authors.lastname: Dawson
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Follicular lymphoma; chemotherapy; frontline; outcomes; rituximab