Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group

Abstract

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%

Improved survival for non-Hodgkin lymphoma patients in New South Wales, Australia

“…This was approximately when rituximab was approved by the Australian Therapeutic Goods Administration for clinical use in Australia for the two commonest NHL subtypes, namely low grade or follicular lymphoma (June 1998) [3] and diffuse large B-cell lymphomas (February 2002) [4]. These results are consistent with the beneficial effects of rituximab on cancer survival observed in clinical trials [23-25]. …”

Rituximab maintenance improves overall survival in follicular lymphoma: A retrospective nationwide real‐world analysis from Taiwan Cancer Registry Database

“…On the contrast, patients with asymptomatic advanced‐stage FL do not need to be treated immediately 1, 5, 6, 7. Once they develop symptoms, chemotherapies with rituximab are suggested as frontline treatments 1, 4, 8, 9, 10, 11…”

“…Rituximab combined with cytotoxic chemotherapies is superior to chemotherapies alone, regardless of frontline treatments or in relapse and/or refractory FL 8, 9, 10, 12, 13, 14, 15. Several prospective trials tried to address the clinical benefits of rituximab maintenance in the patients with FL, but rituximab maintenance only improves progression‐free survival instead of overall survival 16, 17, 18, 19.…”

Radioimmunotherapy for B-cell lymphoma: Y90 ibritumomab tiuxetan and I131 tositumomab

“…Efficacy following previous treatment with rituximab The use of rituximab in the treatment of follicular lymphomas has expanded considerably in recent years based on the results of a number of randomized studies (Hiddemann et al, 2005;Marcus et al, 2005;Forstpointner et al, 2006;van Oers et al, 2006). This begs the question, what is the efficacy of CD20 targeted RIT in patients that have recurred after exposure to rituximab?…”

“…The pattern of CD20 expression is critical, for although it is present on >95% of malignant B cells and is expressed during normal B-cell development, it is absent from the terminally differentiated plasma cell and those at the earliest stages of B-cell lineage commitment Anderson et al, 1984). The unconjugated chimeric monoclonal antibody rituximab (Genentech, South San Francisco, CA, USA and Roche, Basel, Switzerland) targeting CD20 has demonstrated significant single agent efficacy in 'indolent' disease (McLaughlin et al, 1998), but more significantly has resulted in a paradigm shift in the management of B-cell NHL through its use in combination with chemotherapy (Coiffier et al, 2002;Hiddemann et al, 2005;Marcus et al, 2005;Forstpointner et al, 2006;Pfreundschuh et al, 2006). RIT extends the activity of unconjugated antibody, allowing the delivery of radiation to multiple disease sites, minimizing normal organ toxicity.…”