Comparison of Real-World Outcomes in Patients With Follicular Lymphoma Treated With BR Versus RCHOP-Like Regimens

Abstract

Background: Patients with follicular lymphoma (FL) grade (G) 1-3A who meet treatment criteria are commonly treated with chemo-immunotherapy regimens such as bendamustine plus rituximab (BR) or rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone (RCHOP). Two prospective trials have compared BR to RCHOP-like regimens and showed improved progression free survival with BR in FL G1-2 patients. However, in real-world practice, there is clinical variability in utilization of BR versus RCHOP-like regimens. Additionally, the optimal treatment for patients with FL G3A remains unclear.

Methods: We used a nationwide electronic health record-derived de-identified database to compare outcomes in 2089 patients with FL G1-3A treated with frontline BR versus RCHOP-like regimens.

Results: We demonstrated clinical improvement in time to next treatment or death (TTNTD) with BR (median 96 vs. 78 months, HR 1.15, 95% CI 0.986-1.332, P = .086), albeit not statistically significant. No difference in overall survival (OS) was observed. Maintenance rituximab was associated with improved TTNTD and OS. Among G3A patients (N = 304), TTNTD was comparable between the 2 regimens, however OS was significantly improved with RCHOP-like regimens in univariate analysis (median 138 vs. 96 months, HR 0.51, 95% CI 0.313-0.834, P = .007).

Conclusions: In conclusion, this study of real-world patients supports the use of BR and rituximab maintenance for front-line treatment of FL. Further prospective studies are needed to determine the ideal treatment for FL G3A.

Keywords: Chemoimmunotherapy in FL; Grade 3A FL; Maintenance rituximab; Outcomes in FL; Treatment naive FL.