Bendamustine plus rituximab versus R-CHOP as first-line treatment for patients with indolent non-Hodgkin’s lymphoma: evidence from a multicenter, retrospective study

Abstract

The optimal first-line treatment for advanced low-grade non-Hodgkin lymphomas (LG-NHL) is still highly debated. Recently, the StiL and the BRIGHT trials showed that the combination of rituximab and bendamustine (R-B) is non-inferior to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with a better toxicity profile. Utilizing a retrospective analysis, we compared the efficacy and safety of both regimens in clinical practice. From November 1995 to January 2014, 263 LG-NHL patients treated with either R-B or R-CHOP were retrospectively assessed in seven European cancer centers. Ninety patients were treated with R-B and 173 with R-CHOP. Overall response rate was 94 and 92 % for the R-B and the R-CHOP group, respectively. The percentage of complete response was similar for both groups (63 vs. 66 % with R-B and R-CHOP, respectively; p = 0.8). R-B was better tolerated and less toxic than R-CHOP. The median follow-up was 6.8 and 5.9 years for the R-CHOP and the R-B group, respectively. Overall, no difference in progression-free survival (PFS) (108 vs. 110 months; p = 0.1) was observed in the R-B group compared to the R-CHOP cohort. Nevertheless, R-B significantly prolonged PFS in FL patients (152 and 132 months in the R-B and R-CHOP group, respectively; p = 0.05). However, this result was not verified in multivariate analysis probably due to the limits of the present study. We confirm that the R-B regimen administered in patients with LG-NHL is an effective and less toxic therapeutic option than R-CHOP in clinical practice.

The Combination of Rituximab and Bendamustine as First-Line Treatment Is Highly Effective in the Eradicating Minimal Residual Disease in Follicular Lymphoma: An Italian Retrospective Study

“…That statement is well supported by the observation that our clinical results are superimposable to those from other larger and pivotal trials: in particular, in our series CR rate resulted 79%, 2-years PFS 85%, and 2-years OS 94%. These values result comparable to those recently reported by Mondello et al in 192 cases randomized to receive R-bendamustine or R-CHOP (Mondello et al, 2016). Those authors reported the superiority of R-bendamustine, with a significant prolongation of the median PFS (152 vs. 132 months); in that study, bendamustine offered 94% of ORR, and 63% of CR.…”

Bendamustine plus Rituximab Versus R-CHOP as First-Line Treatment for Patients with Follicular Lymphoma Grade 3A: Evidence from a Multicenter, Retrospective Study

“…In the case of transformation into an aggressive lymphoma, R-CHOP is considered the standard of care [53]. As previously reported [23,25], the observed PFS prolongation did not translate into a OS advantage of R-B over R-CHOP. This could be because of the indolent clinical course of FL even after a relapse and the availability of efficient salvage treatments.…”

“…In both trials, the positive impact of R‐B was independent from other prognosticators such as age, lactate dehydrogenase (LDH) levels, and the follicular lymphoma international prognostic index (FLIPI). Moreover, these positive results were confirmed in a real‐life analysis . However, until now, no published data comparing R‐CHOP with R‐B as a first‐line treatment in patients affected by FL3A were available.…”

Bendamustine plus rituximab for indolent B‐cell lymphoma of renal significance

“…Bendamustine is a bifunctional drug that acts as an alkylating and antimetabolite agent with no or little renal clearance . In patients with iNHL, the hematological response following BR reaches 80–90% (complete response 40%‐60%) . Unlike RCD, the lack of steroids with BR may be of interest to patients with diabetes mellitus, chronic kidney disease, or to reduce the risk of infection.…”