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Clinical Trial
. 2023 Jul 1;41(19):3523-3533.
doi: 10.1200/JCO.22.02327. Epub 2023 Apr 18.

Randomized Phase III Trial Evaluating Subcutaneous Rituximab for the First-Line Treatment of Low-Tumor Burden Follicular Lymphoma: Results of a LYSA Study

Guillaume Cartron  1 , Emmanuel Bachy  2 , Hervé Tilly  3 , Nicolas Daguindau  4 , Gian-Matteo Pica  5 , Fontanet Bijou  6 , Christiane Mounier  7 , Aline Clavert  8 , Gandhi Laurent Damaj  9 , Borhane Slama  10 , Olivier Casasnovas  11 , Roch Houot  12 , Krimo Bouabdallah  13 , David Sibon  14 , Olivier Fitoussi  15 , Nadine Morineau  16 , Charles Herbaux  1 , Thomas Gastinne  17 , Luc-Matthieu Fornecker  18 , Corinne Haioun  19 , Vincent Launay  20 , Carla Araujo  21 , Omar Benbrahim  22 , Laurence Sanhes  23 , Remy Gressin  24 , Hugo Gonzalez  25 , Franck Morschhauser  26 , David Ternant  27 , Luc Xerri  28 , Karin Tarte  29 , Delphine Pranger  30
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Free article
Clinical Trial

Randomized Phase III Trial Evaluating Subcutaneous Rituximab for the First-Line Treatment of Low-Tumor Burden Follicular Lymphoma: Results of a LYSA Study

Guillaume Cartron et al. J Clin Oncol. .
Free article

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Abstract

Purpose: Rituximab improves progression-free survival (PFS) and time to next treatment (TTNT) when compared with the watch and wait strategy for patients with low-tumor burden follicular lymphoma (FL). Prolonged rituximab maintenance did not prolong TTNT, whereas it raises concerns about resources use and patient adhesion. Our aim was then to investigate the use of short rituximab maintenance using the subcutaneous (SC) route in patients with low-tumor burden FL.

Methods: Patients with histologically confirmed CD20+ low-tumor burden FL were randomly assigned to receive either rituximab, 375 mg/m2 once daily on D1, D8, D15, and D22, intravenous route (IV, control arm), or rituximab, 375 mg/m2, on day 1 (D1), IV followed by rituximab 1,400 mg total dose, SC once daily on D8, D15, and D22, with maintenance at months 3 (M3), M5, M7, and M9 (experimental arm). The primary end point was PFS. Secondary end points included safety, overall response rates, TTNT, and overall survival (OS).

Results: Two hundred two patients with low-tumor burden FL were randomly assigned to the experimental (n = 100) or control arm (n = 102). The primary end point was met: the 4-year PFS was 58.1% (95% CI, 47.5 to 67.4) and 41.2% (95% CI, 30.6 to 51.6) in experimental and control arms, respectively (hazard ratio, 0.585 [0.393 to 0.871]; P = .0076). Complete response (CR) rates were 59.0% (95% CI, 48.7 to 68.7) in the experimental arm and 36.3% (95% CI, 27.0 to 46.4) in the control arm (P = .001). TTNT and OS were not significantly different. CR was associated with longer PFS and TTNT. High rituximab exposure during the first three months was independently associated with higher CR, PFS, and TTNT.

Conclusion: SC rituximab improves PFS for patients with low-tumor burden FL when used in induction followed by short maintenance. High rituximab exposure during the first 3 months after treatment initiation is, however, the only parameter influencing patient outcomes.

Trial registration: ClinicalTrials.gov NCT02303119.

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