Early Relapse of Follicular Lymphoma After Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone Defines Patients at High Risk for Death: An Analysis From the National LymphoCare Study

• Type of Material: Article
• Authors: Carla Casulo, University of Rochester; Michelle Byrtek, Genentech; Keith L. Dawson, Genentech; Xiaolei Zhou, RTI Health Solutions; Charles M. Farber, Carol G. Simon Cancer Center; Christopher Flowers, Emory University; John D. Hainsworth, Sarah Cannon Research Institute; Matthew J. Maurer, Mayo Clinic; James R. Cerhan, Mayo Clinic; Brian K. Link, University of Iowa; Andrew D. Zelenetz, University of Rochester; Jonathan W. Friedberg
• Language: English
• Date: 2015-08-10
• Publisher: American Society of Clinical Oncology
• Publication Version: Final Published Version
• Copyright Statement: © 2015 by American Society of Clinical Oncology.
• Final Published Version (URL): http://dx.doi.org/10.1200/JCO.2014.59.7534
• Title of Journal or Parent Work: Journal of Clinical Oncology
• ISSN: 0732-183X
• Volume: 33
• Issue: 23
• Start Page: 2516
• End Page: U55
• Grant/Funding Information: Supported by Genentech and F. Hoffmann-La Roche. Support for editorial assistance was funded by Genentech. Funded by P50CA97274 (Cerhan)
• Keywords: R-CVP; RANDOMIZED-TRIAL; Life Sciences & Biomedicine; Oncology; UNITED-STATES; STEM-CELL TRANSPLANTATION; WORKING PARTY; END-POINT; FREE SURVIVAL; PHASE-III; NON-HODGKINS-LYMPHOMA; Science & Technology; 1ST-LINE TREATMENT
• Research Categories: Health Sciences, Oncology; Health Sciences, Pharmacology

Abstract

Purpose: Twenty percent of patients with follicular lymphoma (FL) experience progression of disease (POD) within 2 years of initial chemoimmunotherapy. We analyzed data from the National LymphoCare Study to identify whether prognostic FL factors are associated with early POD and whether patients with early POD are at high risk for death. Patients and Methods: In total, 588 patients with stage 2 to 4 FL received first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Two groups were defined: patients with early POD 2 years or less after diagnosis and those without POD within 2 years, the reference group. An independent validation set, 147 patients with FL who received first-line R-CHOP, was analyzed for reproducibility. Results: Of 588 patients, 19% (n = 110) had early POD, 71% (n = 420) were in the reference group, 8% (n = 46) were lost to follow-up, and 2% (n = 12) died without POD less than 2 years after diagnosis. Five-year overall survival was lower in the early-POD group than in the reference group (50% v 90%). This trend was maintained after we adjusted for FL International Prognostic Index (hazard ratio, 6.44; 95% CI, 4.33 to 9.58). Results were similar for the validation set (FL International Prognostic Index - adjusted hazard ratio, 19.8). Conclusion: In patients with FL who received first-line R-CHOP, POD within 2 years after diagnosis was associated with poor outcomes and should be further validated as a standard end point of chemoimmunotherapy trials of untreated FL. This high-risk FL population warrants further study in directed prospective clinical trials.