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

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...

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Main Authors: Vít Procházka, David Belada, Andrea Janíková, Kateřina Benešová, Heidi Mociková, Juraj Ďuraš, Jan Pirnos, Kateřina Kopečková, Vít Campr, Tomáš Fürst, Robert Pytlík, Alice Sýkorová, Jozef Michalka, Jitka Dlouhá, Tomáš Papajík, Marek Trněný
Format: Article
Language:English
Published: Wiley 2020-07-01
Series:eJHaem
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Online Access:https://doi.org/10.1002/jha2.60
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author Vít Procházka
David Belada
Andrea Janíková
Kateřina Benešová
Heidi Mociková
Juraj Ďuraš
Jan Pirnos
Kateřina Kopečková
Vít Campr
Tomáš Fürst
Robert Pytlík
Alice Sýkorová
Jozef Michalka
Jitka Dlouhá
Tomáš Papajík
Marek Trněný
author_facet Vít Procházka
David Belada
Andrea Janíková
Kateřina Benešová
Heidi Mociková
Juraj Ďuraš
Jan Pirnos
Kateřina Kopečková
Vít Campr
Tomáš Fürst
Robert Pytlík
Alice Sýkorová
Jozef Michalka
Jitka Dlouhá
Tomáš Papajík
Marek Trněný
author_sort Vít Procházka
collection DOAJ
description 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.
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spelling doaj.art-36f7a329607444baa20175f7789312f12023-08-21T14:10:49ZengWileyeJHaem2688-61462020-07-011117018010.1002/jha2.60Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R‐CHOPVít Procházka0David Belada1Andrea Janíková2Kateřina Benešová3Heidi Mociková4Juraj Ďuraš5Jan Pirnos6Kateřina Kopečková7Vít Campr8Tomáš Fürst9Robert Pytlík10Alice Sýkorová11Jozef Michalka12Jitka Dlouhá13Tomáš Papajík14Marek Trněný15Department of Hemato‐Oncology, Faculty of Medicine and Dentistry University Hospital in Olomouc Olomouc Czech RepublicFourth Department of Internal Medicine – Hematology University Hospital Hradec Králové Czech RepublicDepartment of Hematology and Oncology Masaryk University Hospital Brno Brno Czech RepublicFirst Department of Internal Medicine – Hematology First Faculty of Medicine and General Teaching Hospital Prague Czech RepublicDepartment of Internal Medicine and Hematology, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine Charles University Prague Czech RepublicDepartment of Hemato‐Oncology University Hospital Ostrava Ostrava Czech RepublicDepartment of Oncology Hospital České Budějovice České Budějovice Czech RepublicDepartment of Oncology University Hospital Motol Prague Czech RepublicDepartment of Pathology and Molecular Medicine University Hospital in Motol Prague Czech RepublicDepartment of Mathematical Analysis and Applications of Mathematics, Faculty of Science Palacký University Olomouc Czech RepublicFirst Department of Internal Medicine – Hematology First Faculty of Medicine and General Teaching Hospital Prague Czech RepublicFourth Department of Internal Medicine – Hematology University Hospital Hradec Králové Czech RepublicDepartment of Hematology and Oncology Masaryk University Hospital Brno Brno Czech RepublicFirst Department of Internal Medicine – Hematology First Faculty of Medicine and General Teaching Hospital Prague Czech RepublicDepartment of Hemato‐Oncology, Faculty of Medicine and Dentistry University Hospital in Olomouc Olomouc Czech RepublicFirst Department of Internal Medicine – Hematology First Faculty of Medicine and General Teaching Hospital Prague Czech RepublicAbstract 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.https://doi.org/10.1002/jha2.60early progressionfollicular lymphomamaintenancerituximab
spellingShingle Vít Procházka
David Belada
Andrea Janíková
Kateřina Benešová
Heidi Mociková
Juraj Ďuraš
Jan Pirnos
Kateřina Kopečková
Vít Campr
Tomáš Fürst
Robert Pytlík
Alice Sýkorová
Jozef Michalka
Jitka Dlouhá
Tomáš Papajík
Marek Trněný
Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R‐CHOP
eJHaem
early progression
follicular lymphoma
maintenance
rituximab
title Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R‐CHOP
title_full Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R‐CHOP
title_fullStr Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R‐CHOP
title_full_unstemmed Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R‐CHOP
title_short Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R‐CHOP
title_sort rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline r chop
topic early progression
follicular lymphoma
maintenance
rituximab
url https://doi.org/10.1002/jha2.60
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