title: Short duration immunochemotherapy followed by radioimmunotherapy consolidation is effective and well tolerated in relapsed follicular lymphoma: 5-year results from a UK National Cancer Research Institute Lymphoma Group study.
abstract: We report a phase II study to evaluate the efficacy and toxicity of abbreviated immunochemotherapy followed by (90) Y Ibritumomab tiuxetan ((90) Y-IT) in patients with recurrent follicular lymphoma. Of the 52 patients enrolled, 50 were treated with three cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) or R-CVP (rituximab, cyclophosphamide, vincristine, prednisolone), followed by (90) Y-IT regimen (15 MBq/kg, maximum 1200 MBq) preceded by two infusions of 250 mg/m(2) rituximab. The overall response rate was 98% with complete response (CR) 30% and partial response (PR) 68%. 18 patients with a PR following chemotherapy improved to a CR following (90) Y-IT: a conversion rate of 40%. Seven patients with PR following (90) Y-IT subsequently improved to a CR 12-18 months later, leading to an overall CR rate of 44%. With a median follow-up of 5 years, median progression-free survival was 23·1 months and overall survival was 77·5% at 5 years. High trough serum rituximab levels (median 112 μg/ml; range 52-241) were attained after four doses of rituximab, prior to (90) Y-IT; this was not found to influence response rates. The treatment was well tolerated with few (13·5%) grade 3 or 4 infective episodes and manageable haematological toxicity. Abbreviated immunochemotherapy followed by (90) Y-IT is an effective and well-tolerated treatment in recurrent follicular lymphoma patients previously exposed to rituximab.
  
  
  BACKGROUND
  clinicaltrials.gov identifier: NCT00637832.
authors: Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK.
authors: Tim M
authors: TM
authors: Illidge
authors: NIHR/Cancer Research UK Experimental Cancer Medicine Centre, Southampton, UK.
authors: Hayley S
authors: HS
authors: McKenzie
authors: Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK.
authors: Sam
authors: S
authors: Mayes
authors: NIHR/Cancer Research UK Experimental Cancer Medicine Centre, Southampton, UK.
authors: Andrew
authors: A
authors: Bates
authors: NIHR/Cancer Research UK Experimental Cancer Medicine Centre, Southampton, UK.
authors: Andrew J
authors: AJ
authors: Davies
authors: Department of Haematology, St Georges University of London, London, UK.
authors: Ruth
authors: R
authors: Pettengell
authors: Southampton Clinical Trials Unit, Southampton, UK.
authors: Louise
authors: L
authors: Stanton
authors: Southampton Clinical Trials Unit, Southampton, UK.
authors: Kelly
authors: K
authors: Cozens
authors: Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK.
authors: Grace
authors: G
authors: Hampson
authors: Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK.
authors: Caroline
authors: C
authors: Dive
authors: Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK.
authors: Maureen
authors: M
authors: Zivanovic
authors: Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK.
authors: Jill
authors: J
authors: Tipping
authors: Clinical Trials Unit, Velindre Cancer Centre, Cardiff, UK.
authors: Eve
authors: E
authors: Gallop-Evans
authors: Manchester Academic Health Sciences Centre, University of Manchester, Christie NHS Foundation Trust, Manchester, UK.
authors: John A
authors: JA
authors: Radford
authors: NIHR/Cancer Research UK Experimental Cancer Medicine Centre, Southampton, UK.
authors: Peter W M
authors: PW
authors: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000493:pharmacokinetics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods*; D008224:Lymphoma, Follicular / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D016499:Radioimmunotherapy / Q000009:adverse effects / Q000379:methods; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000009:adverse effects; D000069283:Rituximab / Q000493:pharmacokinetics; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; C571759:R-CHOP protocol; D019275:Radiopharmaceuticals; D000069283:Rituximab; C422802:ibritumomab tiuxetan; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: 90Y Ibritumomab; follicular lymphoma; radioimmunotherapy; rituximab; zevalin