First-line treatment with R-CHOP or rituximab-bendamustine in patients with follicular lymphoma grade 3A—results of a retrospective analysis

• Published in: Annals of hematology 2020-12, Vol.99 (12), p.2821-2829
• Main Authors: Pouyiourou, M., Meyer, A., Stroux, A., Viardot, A., La Rosée, P., Maschmeyer, G., Kämpfe, D., Kahl, C., Vucinic, V., Monecke, A., Hirt, C., Weber, T., Meissner, J., Witzens-Harig, M., Böttcher, S., Schmalenberg, H., Marks, R., Prange-Krex, G., Kroschinsky, F., Hauf, E., Keller, U., Koch, K., Klapper, W., Herold, M., Scholz, Christian W.
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Agents, Alkylating - administration & dosage; Antineoplastic Agents, Immunological - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Bendamustine Hydrochloride - administration & dosage; Clinical trials; Cohort Studies; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Female; Follow-Up Studies; Hematology; Humans; Immunotherapy; Lymphoma; Lymphoma, Follicular - diagnosis; Lymphoma, Follicular - drug therapy; Lymphoma, Follicular - mortality; Male; Medicine; Medicine & Public Health; Middle Aged; Monoclonal antibodies; Neoplasm Grading - methods; Oncology; Original Article; Prednisone - administration & dosage; Retrospective Studies; Rituximab - administration & dosage; Survival Rate - trends; Targeted cancer therapy; Treatment Outcome; Vincristine - administration & dosage
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s00277-020-04171-7

Based on centroblast frequency, follicular lymphoma (FL) is subdivided into grades 1-2, 3A, and 3B. Grade FL3A frequently coexists with FL1-2 (FL1-2-3A). Based on clinical trials, FL1-2 is treated with rituximab (R) or obinutuzumab plus bendamustine (B) or CHOP, while FL3B is treated with R-CHOP. In contrast, there are little data guiding therapy in FL3A. We present a retrospective, multicenter analysis of 95 FL3A or FL1-2-3A and 203 FL1-2 patients treated with R-CHOP or R-B first-line. R-CHOP facilitated a higher response rate (95% versus 76%) and longer overall survival (OS) (3-year OS 89% versus 73%, P  = 0.008) in FL3A or FL1-2-3A, whereas the difference in progression-free survival (PFS) did not reach statistical significance. While transformation rates into aggressive lymphoma were similar between both groups, there were more additional malignancies after R-B compared with R-CHOP (6 versus 2 cases). In FL1-2, R-B achieved a higher 3-year PFS (79% versus 47%, P