A randomized controlled trial to evaluate the role of interferon as initial and maintenance therapy in patients with follicular lymphoma

Abstract

The purpose of this study was to evaluate the role of interferon as initial and maintenance therapy in patients with newly diagnosed follicular lymphoma. Between 1984 and 1994, 204 patients with newly diagnosed Stage III or Stage IV follicular lymphoma were randomized to receive either, Chlorambucil (CB): 10 mg daily for 6 weeks, followed by a 2-week interval, with 3 subsequent 2-week treatment periods at the same dose, separated by 2-week intervals, or, CB given concurrently with interferon (IFN). IFN was given at a dose of 3 × 10 6 units thrice weekly, subcutaneously, throughout the 18-week treatment period. Responding patients were subsequently randomized to receive maintenance IFN at the dose and schedule described above, or to expectant management. The overall response rate was 161/204 (78%), complete remission being achieved in 24% of patients. Neither the addition of IFN to the initial treatment, nor the use of maintenance IFN influenced response rate, remission duration or survival. This study was undertaken to determine whether IFN, given in combination with, and then subsequent to, CB would alter the clinical course of patients with follicular lymphoma. Disappointingly, this objective was not achieved, no advantage having been demonstrated for the addition of IFN. © 2001 Cancer Research Campaign http://www.bjcancer.com

Prognostic Factors in Follicular Lymphoma in the Rituximab Era: How to Identify a High-Risk Patient?

“…Extremely valuable for prolonging remission is application of rituximab or ibritumomab-tiuxetan in post-remission (maintenance) therapy [9][10][11][12][13] . A similar effect on remission duration was seen in patients on maintenance treatment with interferon-alpha 14,15 . The successful concept of chemoimmunotherapy is overshadowed by the fact the there is still no agreement as to the optimal initial chemotherapy protocol and individual European and American professional groups prefer particular (or their own) protocols.…”

Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial

“…17,[27][28][29][30][31][32] However, no consistent long-term benefit in terms of OS could be demonstrated, and prolonged administration of both chemotherapy and interferon-␣ are associated with significant toxicity and patient inconvenience.…”

Radiotherapy for Stage I–III Nodal Low-Grade Non-Hodgkin’s Lymphoma

“…These treatments are mostly used as second line therapy or in patients with advanced stage. Interferon alpha seems to have been established as a life-extending therapy for selected patients with follicular lymphoma [1,6,22,23,28,41]. Humanized anti-CD20 monoclonal antibody (rituximab) has a 50% response rate in patients with follicular lymphoma, is still active when given a second time, and has been demonstrating synergistic activity when combined with chemotherapy [6,9,12,17,18,42,44].…”