title: Relationships between chemotherapy, chemotherapy dose intensity and outcomes of follicular lymphoma in the immunochemotherapy era: a report from the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence Molecular Epidemiology Resource.
abstract: The optimal treatment of follicular lymphoma (FL) is not established. Rituximab's value potentially dilutes the impact of chemotherapy on FL. We reviewed 337 cases of FL treated initially with rituximab as monotherapy or with chemotherapy at the University of Iowa/Mayo Clinic from 2002 to 2009, investigating the association between chemotherapy delivery of cyclophosphamide or doxorubicin and survival. With median follow-up duration of 52.7 months, event-free survival (EFS) and overall survival (OS) were similar between the two groups, with a trend toward better EFS in the R-chemotherapy cohort (hazard ratio [HR]=1.24, p=0.28). In the R-chemotherapy group, increased total dose delivery and delivered dose intensity of doxorubicin were associated with improved EFS only in patients who did not receive R-maintenance (HR=0.81; p=0.02 and HR=0.94; p=0.04). Cyclophosphamide delivery was not associated with EFS. Thus, in the immunochemotherapy era, chemotherapy delivery strategy requires re-evaluation.
authors.affiliation: a Department of Medicine , College of Medicine, University of Iowa , Iowa City , IA , USA.
authors.forename: Kitsada
authors.initials: K
authors.lastname: Wudhikarn
authors.affiliation: b Department of Biostatistics , College of Public Health, University of Iowa , Iowa City , IA , USA.|c Holden Comprehensive Cancer Center , Iowa City , IA , USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Smith
authors.affiliation: b Department of Biostatistics , College of Public Health, University of Iowa , Iowa City , IA , USA.|c Holden Comprehensive Cancer Center , Iowa City , IA , USA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Button
authors.affiliation: d Division of Hematology, Mayo Clinic , Rochester , MN , USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.affiliation: d Division of Hematology, Mayo Clinic , Rochester , MN , USA.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: a Department of Medicine , College of Medicine, University of Iowa , Iowa City , IA , USA.|c Holden Comprehensive Cancer Center , Iowa City , IA , USA.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Rosenstein
authors.affiliation: e Department of Pathology , College of Medicine, University of Iowa , Iowa City , IA , USA.
authors.forename: Sergei I
authors.initials: SI
authors.lastname: Syrbu
authors.affiliation: a Department of Medicine , College of Medicine, University of Iowa , Iowa City , IA , USA.|c Holden Comprehensive Cancer Center , Iowa City , IA , USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Weiner
authors.affiliation: f Division of Epidemiology, Mayo Clinic , Rochester , MN , USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
authors.affiliation: a Department of Medicine , College of Medicine, University of Iowa , Iowa City , IA , USA.|c Holden Comprehensive Cancer Center , Iowa City , IA , USA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Link
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008224:Lymphoma, Follicular / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Follicular lymphoma; dose intensity; immunochemotherapy; treatment delivery