FL

Retrospective analysis of bendamustine plus rituximab versus R-CHOP in grade 3A FL

Patrizia Mondello of University of Messina, in Messina Italy, and colleagues published results of a retrospective subgroup analysis comparing bendamustine plus rituximab (B-R) to standard rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) therapy for patients with grade 3A follicular lymphoma. The results were published in the January 9, 2018 issue of The Oncologist journal.

Follicular lymphoma is the most common type of indolent lymphoma. Among histological grades 1, 2, and 3, grade 3 is the most aggressive. Two trials published in the last several years have demonstrated improved outcomes and less toxicity with R-CHOP therapy compared to bendamustine plus rituximab for lymphoma.  This analysis of a randomized trial is the first published data to compare the two treatment regimens in grade 3A follicular lymphoma (FL3A).

Patient Population
  • N = 132 patients
  • Median age
    • B-R: 63 years vs. R-CHOP: 57 years
  • Ki67 >30%
    • B-R: 45% vs. R-CHOP: 19%
  • Bone marrow involvement
    • B-R: 59% vs. R-CHOP: 11%
 Key Findings
  • ORR, CR, SD the same in both groups
  • Dose reductions
    • B-R: 1% vs. R-CHOP: 12%
  • Adverse events
    • Neutropenia: B-R: 6% vs. R-CHOP: 30%
    • Infections: B-R: 5% vs. R-CHOP: 35%
    • Anemia: B-R: 2% vs. R-CHOP: 13%
    • Thrombocytopenia: B-R: 5% vs. R-CHOP: 16%
    • Peripheral neuropathy: B-R: 1% vs.R-CHOP: 45%
    • Rash: B-R: 3% vs. R-CHOP: 15%
    • Secondary malignancy: B-R: 3% vs. R-CHOP: 13%
  • 15-year follow-up outcomes
    • Relapse: B-R: 16% vs. R-CHOP: 41%
    • Death: B-R: 6% vs. R-CHOP: 20%
    • Progression-free survival: B-R: 15 years vs. R-CHOP: 11.7 years

This data represents an option for providing favorable outcomes and reduced toxicity for patients with grade 3A follicular lymphoma. Treatment with bendamustine plus rituximab also provides a long-term survival benefit, with reduced rates of relapse, death and disease progression. Bendumustine plus rituximab represents a very viable treatment option for FL3A patients.

References
  1. Mondello PEt al. Bendamustine plus Rituximab Versus R-CHOP as First-Line Treatment for Patients with Follicular Lymphoma Grade 3A: Evidence from a Multicenter, Retrospective Study. Oncologist. 2018 Jan 9. pii: theoncologist.2017-0037. doi: 10.1634/theoncologist.2017-0037. [Epub ahead of print]