Frontline intensive chemotherapy improves outcome in young, high-risk patients with follicular lymphoma: pair-matched analysis from the Czech Lymphoma Study Group Database

Abstract

Optimal frontline treatment in younger high tumor-burden risk follicular lymphoma patients remains a challenge given the reduced efficacy of standard immunochemotherapy (R-CHOP) in widespread disease and unclear role of intensive induction. The retrospective non-randomized pair-matched (1:3) analysis compared 48 intermediate/high Follicular Lymphoma International Prognostic Index (FLIPI) patients receiving intensive rituximab sequential chemotherapy (R-SQ) with 144 random controls (R-CHOP) matched for age, FLIPI score, and maintenance delivery. Complete response rates were 91.7% and 74.1%, respectively (p = .038). After a median follow-up of 8.8 (R-SQ) and 6.5 years (R-CHOP), 5-year time to treatment failure, progression-free survival, and overall survival were 80.9%, 83.2%, and 100% and 57.5%, 60.3%, and 92.1% (p = .0044; p = .0047; p = .22), respectively. Intensive treatment was accompanied by higher acute hematologic toxicity and infections, comparable non-hematologic toxicity, and incidence of secondary malignancies. Intensive induction demonstrates superior long-term disease control compared to R-CHOP, with higher acute hematologic toxicity, but without acute treatment-related mortality. Further studies are needed to define ultra-high-risk FL patients benefiting most from treatment intensity.

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

“…Details about the development and operation of the CLSG lymphoma registry have been published elsewhere [ 2 , 17 , 18 ]. Briefly, the CLSG database is a nation‐wide prospectively operated registry collecting data since 1999.…”

“…Indeed, it separated a population with different biology and thus in need of a different treatment approach [16,17].…”

“…Identification of early progression of disease, or POD24, became a robust surrogate endpoint for defining ultrahigh‐risk FL patients [ 15 ]. Indeed, it separated a population with different biology and thus in need of a different treatment approach [ 16 , 17 ].…”