Phase 2 studies suggest that the monoclonal antibody rituximab may improve the prognosis of patients with follicular lymphoma (FL) when it is added to chemotherapy. In the current study, 428 patients with untreated, advanced-stage FL were randomly assigned for therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone (n ‫؍‬ 205) or CHOP combined with rituximab (R-CHOP) (n ‫؍‬ 223). R-CHOP reduced the relative risk for treatment failure by 60% and significantly prolonged the time to treatment failure (P < .001). In addition, a significantly higher overall response rate (96% vs 90%; P ‫؍‬ .011) and a prolonged duration of remission (P ‫؍‬ .001) were achieved. In spite of a relatively short observation time, these beneficial effects even translated to superior overall survival (P ‫؍‬ .016), with 6 deaths in the R-CHOP group compared with 17 deaths in the CHOP group within the first 3 years. The predominant treatment-related adverse effect was myelosuppression. Severe granulocytopenia was more frequently observed after R-CHOP (63% vs 53%; P ‫؍‬ .01). However, severe infections were rare and of similar frequency after R-CHOP and CHOP (5% and 7%

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There is no generally established prognostic index for patients with mantle cell lymphoma (MCL),

IntroductionMature T-cell and natural killer (NK)-cell lymphomas are rare and heterogeneous diseases following an aggressive clinical course which necessitates immediate therapy. Outcome is generally believed poor although only 1 recent study 1 comprises all major T-cell lymphoma subtypes according to the World Health Organization classification 2,3 with spin-off studies reporting on clinical outcome and prognostic factors of various subtypes. [4][5][6] In contrast to the progress made in the treatment of aggressive B-cell lymphoma, 7-9 evidence for similar therapeutic improvements in T-and NK-cell lymphoma is largely absent. Therefore, we analyzed a large cohort of patients with T-cell lymphoma who have been treated on protocols of the German High-Grade Non-Hodgkin Lymphoma Study Group (Deutsche Studiengruppe Hochmaligne Non-Hodgkin Lymphome [DSHNHL]). We were particularly interested in the long-term results achieved with "standard" CHOP (cyclophosphamide, hydroxydaunorubicin (doxorubicin), Oncovin (vincristine), and prednisone/prednisolone) and CHOP-like therapy and wanted to define prognostic factors which should influence the decision which patients should be treated on standard or experimental protocols in the future. Methods PatientsBetween October 1993 and May 2007, 343 patients with mature nodal or extranodal T-cell or NK-cell lymphoma 2 were treated on protocols of the DSHNHL. Mandatory reference pathology was performed in 1 of the 6 German Reference Centers for Malignant Lymphomas (Berlin, Frankfurt, Kiel, Lübeck, Ulm, and Würzburg) prior to therapy. Of 343 patients, 320 could be assigned to 1 of the following subtypes: anaplastic large cell lymphoma (ALCL), anaplastic large cell lymphoma kinase-positive (ALKpositive); ALCL, ALK-negative; peripheral T-cell lymphoma unspecified (PTCLU); angioimmunoblastic T-cell lymphoma (AITL); NK/T-cell lymphoma; lymphoblastic lymphoma; enteropathy-type T-cell lymphoma; hepatosplenic ␥␦ T-cell lymphoma; or subcutaneous panniculitis-like T-cell lymphoma. In a subset of ALCL cases the ALK status had not been determined at the time of diagnosis, because antibodies were not available at that time. In these cases, the ALK status was defined retrospectively using the ALK1 antibody from DAKO (dilution 1:80, citrate buffer pH 6.0). The definition of ALK1-negative ALCL followed the current World Health Organization classification and required characteristic large cell morphology (indistinguishable from ALK-positive ALCL), strong and consistent expression of CD30 and negativity for ALK1. Moreover, most cases had expression of at least 1 cytotoxic molecule (Perforin, Granzyme B, or TIA). Twenty-three patients were excluded from the analysis because the ALK For personal use only. on May 12, 2018. by guest www.bloodjournal.org From status of some ALCL patients remained unknown (n ϭ 11) or the T-cell lymphoma subtype could not be confirmed for technical (n ϭ 3) or other reasons (n ϭ 9).All patients had thorough baseline and follow-up assessments (history, clinical evaluation, labor...

The combined immunochemotherapy with R-CHOP resulted in a significantly higher response rate and a prolongation of the TTF as compared with chemotherapy alone. Hence, R-CHOP may serve as a new baseline regimen for advanced stage MCL, but needs to be further improved by novel strategies in remission.