Frontline intensive chemotherapy improves outcome in young, high-risk patients with follicular lymphoma: pair-matched analysis from the Czech Lymphoma Study Group Database.
Optimal frontline treatment in younger high tumor-burden risk follicular lymphoma patients remains a challenge given the reduced efficacy of standard immunochemotherapy (R-CHOP) in widespread disease and unclear role of intensive induction. The retrospective non-randomized pair-matched (1:3) analysis compared 48 intermediate/high Follicular Lymphoma International Prognostic Index (FLIPI) patients receiving intensive rituximab sequential chemotherapy (R-SQ) with 144 random controls (R-CHOP) matched for age, FLIPI score, and maintenance delivery. Complete response rates were 91.7% and 74.1%, respectively (p = .038). After a median follow-up of 8.8 (R-SQ) and 6.5 years (R-CHOP), 5-year time to treatment failure, progression-free survival, and overall survival were 80.9%, 83.2%, and 100% and 57.5%, 60.3%, and 92.1% (p = .0044; p = .0047; p = .22), respectively. Intensive treatment was accompanied by higher acute hematologic toxicity and infections, comparable non-hematologic toxicity, and incidence of secondary malignancies. Intensive induction demonstrates superior long-term disease control compared to R-CHOP, with higher acute hematologic toxicity, but without acute treatment-related mortality. Further studies are needed to define ultra-high-risk FL patients benefiting most from treatment intensity.
a Department of Hemato-Oncology, Faculty of Medicine and Dentistry , Palacky University , Olomouc , Czech Republic.
Vít
V
Procházka
a Department of Hemato-Oncology, Faculty of Medicine and Dentistry , Palacky University , Olomouc , Czech Republic.
Tomáš
T
Papajík
b Department of Hematology and Oncology , University Hospital , Brno , Czech Republic.
Andrea
A
Janíková
c 4th Department of Internal Medicine - Hematology , University Hospital and Faculty of Medicine , Hradec Kralove , Czech Republic.
David
D
Belada
d Department of Clinical Hematology , University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University , Prague , Czech Republic.
Tomáš
T
Kozák
b Department of Hematology and Oncology , University Hospital , Brno , Czech Republic.
David
D
Šálek
c 4th Department of Internal Medicine - Hematology , University Hospital and Faculty of Medicine , Hradec Kralove , Czech Republic.
Alice
A
Sýkorová
d Department of Clinical Hematology , University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University , Prague , Czech Republic.
Heidi
H
Móciková
e Institute of Pathology, University Hospital Motol , Prague , Czech Republic.
Vít
V
Campr
f Data Management Office, 1st Department of Internal Medicine - Department of Hematology , First Faculty of Medicine and General Teaching Hospital , Prague , Czech Republic.
Jitka
J
Dlouhá
g Department of Medical Biophysics, Faculty of Medicine and Dentistry , Palacky University , Olomouc , Czech Republic.
Kateřina
K
Langová
h Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science , Palacký University , Olomouc , Czech Republic.
Tomáš
T
Fürst
i 1st Department of Internal Medicine - Department of Hematology , First Faculty of Medicine and General Teaching Hospital , Prague , Czech Republic.
Marek
M
Trněný
D000328:Adult; D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D060046:Maintenance Chemotherapy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011159:Population Surveillance; D012074:Remission Induction; D016896:Treatment Outcome; D047368:Tumor Burden
Autologous transplantation; chemotherapy; follicular lymphoma; prognosis