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. 2020 Jul 31;1(1):170-180.
doi: 10.1002/jha2.60. eCollection 2020 Jul.

Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R-CHOP

Vít Procházka  1 , David Belada  2 , Andrea Janíková  3 , Kateřina Benešová  4 , Heidi Mociková  5 , Juraj Ďuraš  6 , Jan Pirnos  7 , Kateřina Kopečková  8 , Vít Campr  9   10 , Tomáš Fürst  11 , Robert Pytlík  4 , Alice Sýkorová  2 , Jozef Michalka  3 , Jitka Dlouhá  4 , Tomáš Papajík  1 , Marek Trněný  4
Affiliations

Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R-CHOP

Vít Procházka et al. EJHaem. .

Abstract

Twenty percent of patients with high-tumor-burden (HTB) follicular lymphoma (FL) develop progression/relapse of disease (POD) within 24 months of frontline immunochemotherapy. Unfortunately, about 50% of these patients die within 5 years since POD event. Rituximab maintenance was proven to reduce relapse rate in responding FL, but its role on preventing POD was not defined. We analyzed 1360 HTB-FL patients from the Czech Lymphoma Study Group registry treated with frontline rituximab-containing regimen. Of those, 950 cases received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and achieved complete or partial remission: 712 patients received rituximab maintenance (MAINT) and 238 were a historical observational cohort (OBS). We have proposed a modified POD24 (mPOD24) endpoint for the chemosensitive patients calculated from the end-of-induction (EOI). Survival rates since EOI were as follows: 5-year overall survival (OS) 86.2% versus 94.5% in the OBS and MAINT groups, respectively (P < .001) and 5-year progression-free survival 58.5% (OBS) and 75.4% (MAINT) (P < .001). The Cox proportional hazards model showed a decrease in mPOD24 incidence in the MAINT group with the overall hazard rate reduced by 56% (hazard ratio = 0.44; P < .001). The cumulative incidence of mPOD24 was reduced from 24.1% in OBS to 10.1% in MAINT (P < .001). Comparison of non-mPOD24 cases showed OS similar to that in the general population. Rituximab maintenance given after R-CHOP resulted in a 2.4-fold reduction in mPOD24 incidence. Once the non-POD24 status is achieved, FL does not shorten the patients' life expectancy.

Keywords: early progression; follicular lymphoma; maintenance; rituximab.

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Conflict of interest statement

Vít Procházka provided consultancy (F. Hoffmann‐La Roche AG) and received research funding (Takeda Pharmaceuticals, Inc); Marek Trněný received research funding (Seattle Genetics, Inc), provided consultancy (F. Hoffmann‐La Roche AG), and received speakers´ bureau (F. Hoffmann‐La Roche AG). Other authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
CONSORT flow diagram showing the patient selection process
FIGURE 2
FIGURE 2
Overall survival (OS) comparison of the observational versus rituximab maintenance cohort
FIGURE 3
FIGURE 3
Progression‐free survival (PFS) comparison of the observational versus rituximab maintenance cohort
FIGURE 4
FIGURE 4
Cumulative incidence curves of mPOD24 events
FIGURE 5
FIGURE 5
Overall survival since the end of induction (EOI‐OS). Patients stratified according to the mPOD24 incidence and application of rituximab maintenance therapy
FIGURE 6
FIGURE 6
Cox proportional hazards regression analysis showing the effect of rituximab maintenance on the mPOD24 incidence
FIGURE 7
FIGURE 7
Overall survival of the mPOD24‐free patients compared with general population (GP) survival
See this image and copyright information in PMC

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