Aprospective trial conducted in the period 2000-2005 showed no survival advantage for high-dose chemotherapy with rituximab and autograft (RHDS) versus conventional chemotherapy with rituximab (CHOP-R) as firstline therapy in 134 high-risk follicular lymphoma patients aged <60 years. The study has been updated at the 13-year median follow up. As of February 2017, 88 (66%) patients were alive, with overall survival of 66.4% at 13 years, without a significant difference between R-HDS (64.5%) and CHOP-R (68.5%). To date, 46 patients have died, mainly because of disease progression (47.8% of all deaths), secondary malignancies (3 solid tumor, 9 myelodysplasia/acute leukemia; 26.1% of all deaths), and other toxicities (21.7% of all deaths). Complete remission was documented in 98 (73.1%) patients and associated with overall survival, with 13- year estimates of 77.0% and 36.8% for complete remission versus no-complete remission, respectively. Molecular remission was documented in 39 (65%) out of 60 evaluable patients and associated with improved survival. In multivariate analysis, complete remission achievement had the strongest effect on survival (P<0.001), along with younger age (P=0.002) and female sex (P=0.013). Overall, 50 patients (37.3%) survived with no disease recurrence (18 CHOP-R, 32 R-HDS). This follow up is the longest reported on follicular lymphoma treated upfront with rituximab-chemotherapy and demonstrates an unprecedented improvement in survival compared to the pre-rituximab era, regardless of the use of intensified or conventional treatment. Complete remission was the most important factor for prolonged survival and a high proportion of patients had prolonged survival in their first remission, raising the issue of curability in follicular lymphoma.

Prolonged survival in the absence of disease-recurrence in advanced-stage follicular lymphoma following chemo-immunotherapy: 13-year update of the prospective, multicenter randomized GITMO-IIL trial / Bruna, R.; Benedetti, F.; Boccomini, C.; Patti, C.; Barbui, A. M.; Pulsoni, A.; Musso, M.; Liberati, A. M.; Gini, G.; Castellino, C.; Rossini, F.; Ciceri, F.; Rota-Scalabrini, D.; Stelitano, C.; Di Raimondo, F.; Tucci, A.; Devizzi, L.; Zoli, V.; Zallio, F.; Narni, F.; Dondi, A.; Parvis, G.; Semenzato, G.; Lanza, F.; Perrone, T.; Angrilli, F.; Billio, A.; Gueli, A.; Mantoan, B.; Rambaldi, A.; Massimo Gianni, A.; Corradini, P.; Passera, R.; Ladetto, M.; Tarella, C.. - In: HAEMATOLOGICA. - ISSN 0390-6078. - 104:11(2019), pp. 2241-2248. [10.3324/haematol.2018.209932]

Prolonged survival in the absence of disease-recurrence in advanced-stage follicular lymphoma following chemo-immunotherapy: 13-year update of the prospective, multicenter randomized GITMO-IIL trial

Pulsoni A.;
2019

Abstract

Aprospective trial conducted in the period 2000-2005 showed no survival advantage for high-dose chemotherapy with rituximab and autograft (RHDS) versus conventional chemotherapy with rituximab (CHOP-R) as firstline therapy in 134 high-risk follicular lymphoma patients aged <60 years. The study has been updated at the 13-year median follow up. As of February 2017, 88 (66%) patients were alive, with overall survival of 66.4% at 13 years, without a significant difference between R-HDS (64.5%) and CHOP-R (68.5%). To date, 46 patients have died, mainly because of disease progression (47.8% of all deaths), secondary malignancies (3 solid tumor, 9 myelodysplasia/acute leukemia; 26.1% of all deaths), and other toxicities (21.7% of all deaths). Complete remission was documented in 98 (73.1%) patients and associated with overall survival, with 13- year estimates of 77.0% and 36.8% for complete remission versus no-complete remission, respectively. Molecular remission was documented in 39 (65%) out of 60 evaluable patients and associated with improved survival. In multivariate analysis, complete remission achievement had the strongest effect on survival (P<0.001), along with younger age (P=0.002) and female sex (P=0.013). Overall, 50 patients (37.3%) survived with no disease recurrence (18 CHOP-R, 32 R-HDS). This follow up is the longest reported on follicular lymphoma treated upfront with rituximab-chemotherapy and demonstrates an unprecedented improvement in survival compared to the pre-rituximab era, regardless of the use of intensified or conventional treatment. Complete remission was the most important factor for prolonged survival and a high proportion of patients had prolonged survival in their first remission, raising the issue of curability in follicular lymphoma.
2019
advanced-stage follicular lymphoma; chemoimmunotherapy; non-Hodgkin lymphoma
01 Pubblicazione su rivista::01a Articolo in rivista
Prolonged survival in the absence of disease-recurrence in advanced-stage follicular lymphoma following chemo-immunotherapy: 13-year update of the prospective, multicenter randomized GITMO-IIL trial / Bruna, R.; Benedetti, F.; Boccomini, C.; Patti, C.; Barbui, A. M.; Pulsoni, A.; Musso, M.; Liberati, A. M.; Gini, G.; Castellino, C.; Rossini, F.; Ciceri, F.; Rota-Scalabrini, D.; Stelitano, C.; Di Raimondo, F.; Tucci, A.; Devizzi, L.; Zoli, V.; Zallio, F.; Narni, F.; Dondi, A.; Parvis, G.; Semenzato, G.; Lanza, F.; Perrone, T.; Angrilli, F.; Billio, A.; Gueli, A.; Mantoan, B.; Rambaldi, A.; Massimo Gianni, A.; Corradini, P.; Passera, R.; Ladetto, M.; Tarella, C.. - In: HAEMATOLOGICA. - ISSN 0390-6078. - 104:11(2019), pp. 2241-2248. [10.3324/haematol.2018.209932]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1347650
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