Rituximab Added to First-Line Mitoxantrone, Chlorambucil, and Prednisolone Chemotherapy Followed by Interferon Maintenance Prolongs Survival in Patients With Advanced Follicular Lymphoma: An East German Study Group Hematology and Oncology Study

Abstract

The R-MCP regimen significantly improves complete and overall response rates, EFS, PFS, and OS in patients with previously untreated advanced FL, without a clinically significant increase in toxicity.

Long-term follow up of the FL2000 study comparing CHVP-interferon to CHVP-interferon plus rituximab in follicular lymphoma

“…[5][6][7][8][9][10] However, long-term follow up of randomized trials are mandatory to ascertain whether improvement in progression-or event-free survival actually translates into sustained longer overall survival and whether the experimental treatment does not yield unexpected long-term toxicity or impairment in the use of a second-line regimen. In the present study, we report the long-term follow up of patients enrolled in the FL2000 study, in which the addition of rituximab was compared with the previous standard regimen of our co-operative group (CHVP+I) for patients with de novo FL.…”

“…3,4 Although no consensus has been reached on the regimen of chemotherapy (CHOP, CVP, MCP or bendamustine), anti-CD20 antibodies are now systematically combined with chemotherapy in FL since four randomized trials and one meta-analysis have demonstrated superior outcome for rituximab (R)-containing regimen in the first-line setting. [5][6][7][8][9][10] Rchemotherapy has, therefore, become a new standard of care for disseminated FL worldwide and its broad use contributed to the recently described improvement in outcome after decades of disappointing results for this disease. [11][12][13] Given the prolonged overall survival (OS) in patients with FL, progression-or event-free survival (PFS or EFS) have been widely used as surrogate markers for evaluation of OS end point in clinical trials.…”

A phase 1 study of obinutuzumab induction followed by 2 years of maintenance in patients with relapsed CD20-positive B-cell malignancies

“…Rituximab, a type I chimeric IgG1 anti-CD20 antibody, given alone or in combination with standard chemotherapy regimens, is associated with increased response rates and improved progression free-survival and overall survival with an acceptable safety profile. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Maintenance therapy with rituximab has been demonstrated to significantly improve responses and progression free-survival in both previously untreated and relapsed follicular lymphoma (FL). [16][17][18] However, indolent lymphomas, such as FL and chronic lymphocytic leukemia (CLL) remain incurable, with patients exhibiting relapses after each treatment, highlighting the need for more effective therapies.…”

Changing therapeutic landscape – The last decade

“…This effect is not limited to clinical trials but has been substantiated in community-based epidemiological studies [5]. And while the difference in survival in patients with indolent lymphomas seems at first glance less impressive (around 2.5% per year), one should keep in mind that no other drug or therapeutic procedure has ever been consistently shown to improve survival in this patient population [6][7][8][9][10]. The second reason for rituximab popularity is that its toxicity is almost negligible, apart Aurer 4 from occasional infusional and allergic reactions, a slight increase in granulocytopenia that is of doubtful clinical significance and the propensity to cause hypogammaglobulinemia in patients receiving prolonged maintenance treatment.…”