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Annals of Oncology Advance Access originally published online on December 13, 2007
Annals of Oncology 2008 19(3):553-559; doi:10.1093/annonc/mdm511
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© The Author 2007. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

hematologic malignancies

The addition of rituximab to CHOP chemotherapy improves overall and failure-free survival for follicular grade 3 lymphoma

M. J. Overman1, L. Feng2, B. Pro3, P. McLaughlin3, M. Hess3, F. Samaniego3, A. Younes3, J. E. Romaguera3, F. B. Hagemeister3, L. Kwak3, F. Cabanillas4, M. A. Rodriguez3 and L. E. Fayad3,*

1 Department of Gastrointestinal Medical Oncology
2 Department of Biostatistics and Applied Mathematics
3 Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
4 Hospital Auxilio Mutuo Cancer Center, San Juan, Puerto Rico

* Correspondence to: Dr L. E. Fayad, Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Unit 429, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: +1-713-792-2860; Fax: +1-713-794-5656; E-mail: lefayad{at}mdanderson.org

Background: The benefit of adding rituximab to anthracycline-based therapy for follicular lymphoma grade 3 has not been studied.

Patients and methods: We retrospectively reviewed the records of 45 patients with follicular grade 3 lymphoma who were treated with rituximab and the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) at The University of Texas MD Anderson Cancer Center. Response rate, failure-free survival (FFS), and overall survival (OS) were estimated and a historical comparison to CHOP-only-treated patients was made.

Results: The International Prognostic Index (IPI) distribution was 47% low, 36% low intermediate, 13% high intermediate, and 4% high risk. The complete response rate was 96%. Forty-four of 45 patients are still alive. Median follow-up for the alive patients is 3.5 years. The 3-year FFS rate according to the IPI was 80% [95% confidence interval (CI) 64% to 100%] in low, 81% in low intermediate (95% CI 64% to 100%), and 50% (95% CI 25% to 100%) in high-intermediate/high-risk patient group. The addition of rituximab to CHOP improved both 5-year FFS, 71% (95% CI 58% to 87%) compared with 44% (95% CI 36% to 55%) with P value of 0.019, and 5-year OS, 98% (95% CI 93% to 100%) compared with 75% (95% CI 67% to 84%) with P value of 0.0034.

Conclusion: The addition of rituximab to CHOP provided a high response rate and excellent early survival. Poor-risk patients continue to demonstrate a high rate of failure despite the use of rituximab.

Key words: CHOP, follicular lymphoma grade 3, outcome, rituximab, therapy

Received for publication September 28, 2007. Accepted for publication October 2, 2007.


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