Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2013 Dec 1;19(23):6624-32.
doi: 10.1158/1078-0432.CCR-13-1120. Epub 2013 Oct 15.

A comparative analysis of prognostic factor models for follicular lymphoma based on a phase III trial of CHOP-rituximab versus CHOP + 131iodine--tositumomab

Oliver W Press  1 , Joseph M Unger, Lisa M Rimsza, Jonathan W Friedberg, Michael LeBlanc, Myron S Czuczman, Mark Kaminski, Rita M Braziel, Catherine Spier, Ajay K Gopal, David G Maloney, Bruce D Cheson, Shaker R Dakhil, Thomas P Miller, Richard I Fisher
Affiliations
Comparative Study

A comparative analysis of prognostic factor models for follicular lymphoma based on a phase III trial of CHOP-rituximab versus CHOP + 131iodine--tositumomab

Oliver W Press et al. Clin Cancer Res. .

Abstract

Purpose: There is currently no consensus on optimal frontline therapy for patients with follicular lymphoma. We analyzed a phase III randomized intergroup trial comparing six cycles of CHOP-R (cyclophosphamide-Adriamycin-vincristine-prednisone (Oncovin)-rituximab) with six cycles of CHOP followed by iodine-131 tositumomab radioimmunotherapy (RIT) to assess whether any subsets benefited more from one treatment or the other, and to compare three prognostic models.

Experimental design: We conducted univariate and multivariate Cox regression analyses of 532 patients enrolled on this trial and compared the prognostic value of the FLIPI (follicular lymphoma international prognostic index), FLIPI2, and LDH + β2M (lactate dehydrogenase + β2-microglobulin) models.

Results: Outcomes were excellent, but not statistically different between the two study arms [5-year progression-free survival (PFS) of 60% with CHOP-R and 66% with CHOP-RIT (P = 0.11); 5-year overall survival (OS) of 92% with CHOP-R and 86% with CHOP-RIT (P = 0.08); overall response rate of 84% for both arms]. The only factor found to potentially predict the impact of treatment was serum β2M; among patients with normal β2M, CHOP-RIT patients had better PFS compared with CHOP-R patients, whereas among patients with high serum β2M, PFS by arm was similar (interaction P value = 0.02).

Conclusions: All three prognostic models (FLIPI, FLIPI2, and LDH + β2M) predicted both PFS and OS well, though the LDH + β2M model is easiest to apply and identified an especially poor risk subset. In an exploratory analysis using the latter model, there was a statistically significant trend suggesting that low-risk patients had superior observed PFS if treated with CHOP-RIT, whereas high-risk patients had a better PFS with CHOP-R.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosure

Oliver W. Press (Principal Investigator) – consultancy with Roche/Genentech and clinical trial research funding from Roche/Genentech to the Fred Hutchinson Cancer Research Center. Joseph M. Unger – no conflict of interest. Lisa M. Rimsza – no conflict of interest. Jonathan W. Friedberg – consultancy with Genentech. Michael LeBlanc – no conflict of interest. Myron S. Czuczman - consultancy with Genentech Pharmaceuticals and Spectrum Pharmaceuticals. Mark S. Kaminski – research funding from GlaxoSmithKline; royalties from patents on CD20 Radioimmunotherapy. Rita M. Braziel – no conflict of interest. Catherine M. Spier – no conflict of interest. Ajay K. Gopal – consultancy with Seattle Genetics; honoraria from Seattle Genetics and Millennium/Takeda; research funding from Seattle Genetics, GlaxoSmithKline, Spectrum, Lilly, SBio, Piramal, Abbott, and Emergent Biosolutions. David G. Maloney – honoraria from Genentech, Roche, and GlaxoSmithKline; research funding from Genentech. Bruce D. Cheson – consultancy with Roche-Genentech. Shaker Dakhil – no conflict of interest. Thomas P. Miller – no conflict of interest. Richard I. Fisher – consultancy with Roche.

Figures

Figure 1
Figure 1
Progression Free Survival of Advanced Follicular Lymphoma Patients Enrolled on Intergroup Protocol S0016, stratified according to treatment arm and by serum beta 2 microglobulin Level.
Figure 2
Figure 2
Progression Free Survival (2a, 2c) and Overall Survival (2b, 2d) of Advanced Follicular Lymphoma Patients Enrolled on Intergroup Protocol S0016, stratified according to FLIPI (2a, 2b) or FLIPI2 Risk Groups (2c, 2d).
Figure 3
Figure 3
Progression Free Survival (3A, 3C) and Overall Survival (3B, 3D) of Advanced Follicular Lymphoma Patients Enrolled on Intergroup Protocol S0016, stratified according to the β2M + LDH Prognostic Model using either the Institutional Upper Limit of Normal (3A, 3B) or 150% of the IULN (3C, 3D) as cutpoints for both variables.
Figure 4
Figure 4
Progression Free Survival (4A) and Overall Survival (4B) of Advanced Follicular Lymphoma Patients Enrolled on Intergroup Protocol S0016 stratified according to risk group defined by the LDH + beta 2 microglobulin prognostic model (split at 150% of the IULN) and treatment arm.
See this image and copyright information in PMC

References

    1. Press OW. Follicular Lymphoma. In: Kaushansky K, Lichtman M, Beutler E, Kipps TJ, Seligsohn, Prchal, editors. Williams’ Hematology. 8. New York: McGraw-Hill, Medical Pub. Division; 2010. pp. 1565–74.
    1. Zelenetz AD, Abramson JS, Advani RH, Andreadis CB, Bartlett N, Bellam N, et al. Non-Hodgkin’s lymphomas. J Natl Compr Canc Netw. 2011;9:484–560. - PubMed
    1. Fisher RI, LeBlanc M, Press OW, Maloney DG, Unger JM, Miller TP. New treatment options have changed the survival of patients with follicular lymphoma. J Clin Oncol. 2005;23:8447–52. - PubMed
    1. Swenson WT, Wooldridge JE, Lynch CF, Forman-Hoffman VL, Chrischilles E, Link BK. Improved survival of follicular lymphoma patients in the United States. J Clin Oncol. 2005;23:5019–26. - PubMed
    1. Liu Q, Fayad L, Cabanillas F, Hagemeister FB, Ayers GD, Hess M, et al. Improvement of overall and failure-free survival in stage IV follicular lymphoma: 25 years of treatment experience at The University of Texas M.D. Anderson Cancer Center. J Clin Oncol. 2006;24:1582–9. - PubMed

Publication types

MeSH terms

Grants and funding