Early relapse of follicular lymphoma after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone defines patients at high risk for death: An analysis from the National LymphoCare Study Journal Article


Authors: Casulo, C.; Byrtek, M.; Dawson, K. L.; Zhou, X.; Farber, C. M.; Flowers, C. R.; Hainsworth, J. D.; Maurer, M. J.; Cerhan, J. R.; Link, B. K.; Zelenetz, A. D.; Friedberg, J. W.
Article Title: Early relapse of follicular lymphoma after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone defines patients at high risk for death: An analysis from the National LymphoCare Study
Abstract: Purpose: Twenty percent of patients with follicular lymphoma (FL) experience progression of disease (POD) within 2 years of initial chemoimmunotherapy. We analyzed data from the National LymphoCare Study to identify whether prognostic FL factors are associated with early POD and whether patients with early POD are at high risk for death. Patients and Methods: In total, 588 patients with stage 2 to 4 FL received first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Two groups were defined: patients with early POD 2 years or less after diagnosis and those without POD within 2 years, the reference group. An independent validation set, 147 patients with FL who received first-line R-CHOP, was analyzed for reproducibility. Results: Of 588 patients, 19% (n = 110) had early POD, 71% (n = 420) were in the reference group, 8% (n = 46) were lost to follow-up, and 2% (n = 12) died without POD less than 2 years after diagnosis. Five-year overall survival was lower in the early-POD group than in the reference group (50% v 90%). This trend was maintained after we adjusted for FL International Prognostic Index (hazard ratio, 6.44; 95% CI, 4.33 to 9.58). Results were similar for the validation set (FL International Prognostic Index - adjusted hazard ratio, 19.8). Conclusion: In patients with FL who received first-line R-CHOP, POD within 2 years after diagnosis was associated with poor outcomes and should be further validated as a standard end point of chemoimmunotherapy trials of untreated FL. This high-risk FL population warrants further study in directed prospective clinical trials. © 2015 by American Society of Clinical Oncology.
Keywords: adult; cancer survival; treatment outcome; aged; major clinical study; overall survival; prednisone; disease course; cancer recurrence; doxorubicin; cancer combination chemotherapy; cancer patient; rituximab; cancer staging; follow up; reproducibility; cyclophosphamide; vincristine; cancer mortality; high risk patient; survival time; hazard ratio; follicular lymphoma; cancer prognosis; follicular lymphoma international prognostic index; very elderly; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 33
Issue: 23
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2015-08-10
Start Page: 2516
End Page: 2522
Language: English
DOI: 10.1200/jco.2014.59.7534
PROVIDER: scopus
PUBMED: 26124482
PMCID: PMC4879714
DOI/URL:
Notes: Presented in part at the 55th Annual Meeting of the American Society of Hematology, New Orleans, LA, December 7-10, 2013. - Export Date: 2 October 2015 -- Source: Scopus
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  1. Andrew D Zelenetz
    546 Zelenetz