Bendamustine plus rituximab versus R-CHOP as first-line treatment for patients with indolent non-Hodgkin's lymphoma: evidence from a multicenter, retrospective study.
The optimal first-line treatment for advanced low-grade non-Hodgkin lymphomas (LG-NHL) is still highly debated. Recently, the StiL and the BRIGHT trials showed that the combination of rituximab and bendamustine (R-B) is non-inferior to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with a better toxicity profile. Utilizing a retrospective analysis, we compared the efficacy and safety of both regimens in clinical practice. From November 1995 to January 2014, 263 LG-NHL patients treated with either R-B or R-CHOP were retrospectively assessed in seven European cancer centers. Ninety patients were treated with R-B and 173 with R-CHOP. Overall response rate was 94 and 92 % for the R-B and the R-CHOP group, respectively. The percentage of complete response was similar for both groups (63 vs. 66 % with R-B and R-CHOP, respectively; p = 0.8). R-B was better tolerated and less toxic than R-CHOP. The median follow-up was 6.8 and 5.9 years for the R-CHOP and the R-B group, respectively. Overall, no difference in progression-free survival (PFS) (108 vs. 110 months; p = 0.1) was observed in the R-B group compared to the R-CHOP cohort. Nevertheless, R-B significantly prolonged PFS in FL patients (152 and 132 months in the R-B and R-CHOP group, respectively; p = 0.05). However, this result was not verified in multivariate analysis probably due to the limits of the present study. We confirm that the R-B regimen administered in patients with LG-NHL is an effective and less toxic therapeutic option than R-CHOP in clinical practice.
Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125, Messina, Italy. patriziamondello@hotmail.it.|Department of Biological and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres n°31, 98166, Messina, Italy. patriziamondello@hotmail.it.|Lymphoma Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 330, New York, NY, 10065, USA. patriziamondello@hotmail.it.
Patrizia
P
Mondello
Internal Medicine V: Hematology & Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Normann
N
Steiner
Internal Medicine V: Hematology & Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Wolfgang
W
Willenbacher
Internal Medicine V: Hematology & Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Ines
I
Wasle
Hematology, DISM, AOUD S. M. Misericordia, Piazzale Santa Maria della Misericordia, 33100, Udine, Italy.
Francesco
F
Zaja
Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Via 8 Febbraio 1848, 35122, Padova, Italy.
Renato
R
Zambello
Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Via 8 Febbraio 1848, 35122, Padova, Italy.
Andrea
A
Visentin
Department of Internal Medicine, Pordenone General Hospital, Via Montereale, 33170, Pordenone, Italy.
Endri
E
Mauro
Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, via Nizza 52, 10126, Turin, Italy.
Simone
S
Ferrero
Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, via Nizza 52, 10126, Turin, Italy.
Paola
P
Ghione
Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
Vincenzo
V
Pitini
Department of Biological and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D'Alcontres n°31, 98166, Messina, Italy.
Salvatore
S
Cuzzocrea
Internal Medicine V: Hematology & Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.|Department of Hematology & CBMT, Ospedale di Bolzano, Via Lorenz Böhler, 5, Bolzano, Italy.
Michael
M
Mian
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D000069461:Bendamustine Hydrochloride / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage*; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D000069461:Bendamustine Hydrochloride; D011241:Prednisone
Bendamustine; First-line therapy; Follicular lymphoma; Indolent lymphoma; R-CHOP