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Lymphoma and Pets
High-Dose Sequential Chemotherapy with Rituxan® is Superior to CHOP-R for Poor Risk Follicular Lymphoma
Patients with follicular lymphoma often receive moderate dose chemotherapy until they fail to respond. Then, many receive an autologous transplant as salvage therapy. A previous study by the same Italian researchers showed that high-dose chemotherapy produced complete molecular remissions in 61% of patients and that these patients had an 85% DFS at 54 months (see first item in related news).
The current study was a randomized trial involving 136 poor risk patients with FL. They were randomly allocated to receive 6 cycles of CHOP-R or an intensive induction regimen that included 3 phases: (1) 2 APO and 2 DHAP courses, (2) etoposide cyclophosphamide and Rituxan followed by stem cell harvest and (3) high-dose chemotherapy with mitoxantrone and Alkeran® (melphalan) with stem cell infusion. This was a crossover study and patients who failed R-CHOP could receive Rituxan supplemented high-dose sequential chemotherapy. There were 4 toxic deaths; 2 in each arm. Disease progression occurred in 28% of the R-CHOP patients and 10% of the high-dose group. Two thirds of the patients failing R-CHOP crossed over to receive high-dose sequential therapy and 73% achieved a CR. Event-free survival at 40 months was approximately 65% for the high-dose group and 20% for the CHOP group. However, 83% of patients survived at 36 months in both arms. A stable molecular remission was achieved in 28% of R-CHOP patients and 78% of the high-dose group.
Ladetto M, de Marco F, Benedetti F, et al. Clinical and molecular results of the multicenter randomized GITMO-IIL trial in poor risk follicular lymphoma (FL) at diagnosis: Rituximab-supplemented high-dose sequential chemotherapy (R-HDS) is superior to CHOP-R in molecular remissions rate, EFS and PFS. Blood 2006;108:101a, abstract 325.