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Abstract
The optimal treatment of follicular lymphoma (FL) is not established. Rituximab’s value potentially dilutes the impact of chemotherapy on FL. We reviewed 337 cases of FL treated initially with rituximab as monotherapy or with chemotherapy at the University of Iowa/Mayo Clinic from 2002 to 2009, investigating the association between chemotherapy delivery of cyclophosphamide or doxorubicin and survival. With median follow-up duration of 52.7 months, event-free survival (EFS) and overall survival (OS) were similar between the two groups, with a trend toward better EFS in the R-chemotherapy cohort (hazard ratio [HR] = 1.24, p = 0.28). In the R-chemotherapy group, increased total dose delivery and delivered dose intensity of doxorubicin were associated with improved EFS only in patients who did not receive R-maintenance (HR = 0.81; p = 0.02 and HR = 0.94; p = 0.04). Cyclophosphamide delivery was not associated with EFS. Thus, in the immunochemotherapy era, chemotherapy delivery strategy requires re-evaluation.
Acknowledgements
We acknowledge the collective contribution of the medical, nursing and administrative staff of the UI/MC Lymphoma SPORE. Dr. Christopher Flowers and Dr. John Leonard kindly reviewed the study design and the manuscript as mentors in the American Society of Hematology (ASH) Clinical Research Training Institute (CRTI).
The study was supported in part by Grant No. P50 CA97274 from the National Institutes of Health, and Dr. Wudhikarn is a scholar of ASH's CRTI.
Potential conflict of interest
Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.
Supplementary material available online
Supplementary Tables I–II showing further data