Rituximab maintenance therapy significantly prolonged progression-free survival (PFS) in patients with newly diagnosed follicular lymphoma (FL) given R-CHOP [cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab] versus rituximab plus bendamustine (BR), according to data being presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting and Exposition.

“To date, there is no data to guide treatment choices in patients with FL with high SUV_max but with no documented evidence of HT. Specifically, it remains unclear whether anthracycline-containing regimens, such as R-CHOP, provide a better outcome than BR,” explained Patrizia Mondello, MD, PhD, MSc, Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, and colleagues.

“Furthermore, it is unknown whether rituximab (R) maintenance is beneficial in this setting,” they continued.

Thus, the investigators retrospectively identified 261 patients (median age, 59 years) with newly diagnosed biopsy-proven FL who received front-line R-CHOP (n = 183) or BR (n = 78) at US cancer centers in an effort to compare the efficacy of R-CHOP with BR and clarify the role of maintenance.

They measured the rate of progression-free survival (PFS) from the start of therapy until disease progression, relapse, or death occurred.

Disease progression was reported at the end of treatment in 11 and 14 patients receiving R-CHOP and BR, respectively (6% vs 18%; P = .02), with a higher rate of HT in the BR group (13% vs 4%; P = .006).

According to Dr Mondello et al, there were no significant differences in PFS between recipients of R-CHOP and BR (hazard ratio [HR], 1.22; P = .34) after a median follow-up of 76 months, as well as a trend toward overall survival (OS) benefit with R-CHOP.

Approximately 30% of those with treatment responses after undergoing R-CHOP or BR (n = 170 and n = 64, respectively) received rituximab maintenance (median, 8 administrations). As per a landmark analysis, a significant PFS advantage was reported with rituximab maintenance (HR, 0.53; P = .02) but yielded no survival benefit (HR, 0.67; P = .49).

Notably, the 2-year HT rate and cumulative incidence did not statistically differ between the treatment arms (P = .159).

There were occurrences of early progression (POD24) in 43 and 22 patients given R-CHOP and BR, respectively (24% vs 28%), which led to a significantly higher risk for death (HR, 4.12; P = .006).

“In newly diagnosed FL patients with SUV_max≥13 at baseline PET, R-CHOP was more effective in achieving CR and reducing the risk of early HT compared with BR, and it was associated with a trend toward survival advantage,” Dr Mondello and colleagues wrote.

“Rituximab maintenance significantly prolonged PFS,” they concluded.—Hina Porcelli

Mondello P, Strati P, Merryman RW, et al. R-CHOP Versus R-Bendamustine with or without Rituximab Maintenance in Newly Diagnosed Follicular Lymphoma Patients with High SUV at Baseline PET. Presented at: the 62nd ASH Annual Meeting and Exposition; December 5-8, 2020; virtual. Abstract 2041.