Chlorambucil-rituximab as first-line therapy in patients affected by follicular non-Hodgkin's lymphoma: A retrospective single-centre study

Giovanni Martinelli, Juan Montoro, Anna Vanazzi, Giovanna Andreola, Sarah Liptrott, Davide Radice, Mara Negri, Lorenzo Preda, Giancarlo Pruneri, Daniele Laszlo

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5 Citations (Scopus)

Abstract

Rituximab, a chimeric monoclonal antibody directed against the CD20 antigen, has been shown to be active in newly diagnosed and relapsed patients with follicular lymphoma (FL), both as monotherapy and in combination with chemotherapy. Many studies suggest that the prognosis of patients with FL may improve when it is used in combination with chemotherapy. Despite these advances, the disease remains essentially incurable with standard therapy, and novel approaches to treatment are needed because optimal therapy is not defined. The combination of chlorambucil-rituximab is one of several standard treatment options for FL. Here, we considered data arising from 75 patients with newly diagnosed FL at the European Institute of Oncology treated with the combination of rituximab plus chlorambucil. The aim of this study was to evaluate the efficacy and safety of chlorambucil and rituximab, delivered 6mg/m2/day orally for 6weeks and 375mg/m2 in a standard 4-weekly schedule, respectively. Patients responding to the induction therapy received a prolonged therapy with four additional cycles of chlorambucil plus rituximab. Seventy-one patients (94.6%) completed the treatment; four patients discontinued treatment because of grade 3-4 hematological toxicity. The overall response rate was 97.3% including 74.7% of complete responses. Only two patients had a stable disease at revaluation after treatment. With a median follow-up of 57months, 72 patients (96%) are alive. Median event-free survival (EFS) and median overall survival (OS) were not reached; 5-year OS rate was 98.4%. The 5-year EFS was 71.3%. By univariate and multivariate analyses, elevated beta-2 microglobulin levels and partial responses to therapy were correlated with worse EFS. These results suggest that the combination of chlorambucil and rituximab is an active and safe regimen in patients with newly diagnosed FL, principally in those with low tumour burden and favourable prognostic factors.

Original languageEnglish
Pages (from-to)129-135
Number of pages7
JournalHematological Oncology
Volume33
Issue number4
DOIs
Publication statusPublished - Dec 1 2015

Fingerprint

Chlorambucil
Follicular Lymphoma
Non-Hodgkin's Lymphoma
Disease-Free Survival
Therapeutics
Combination Drug Therapy
CD20 Antigens
Rituximab
beta 2-Microglobulin
Tumor Burden
Appointments and Schedules
Multivariate Analysis
Survival Rate
Monoclonal Antibodies

Keywords

  • Chlorambucil
  • Clinical outcome
  • Follicular lymphoma
  • Rituximab
  • Toxicity

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

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title = "Chlorambucil-rituximab as first-line therapy in patients affected by follicular non-Hodgkin's lymphoma: A retrospective single-centre study",
abstract = "Rituximab, a chimeric monoclonal antibody directed against the CD20 antigen, has been shown to be active in newly diagnosed and relapsed patients with follicular lymphoma (FL), both as monotherapy and in combination with chemotherapy. Many studies suggest that the prognosis of patients with FL may improve when it is used in combination with chemotherapy. Despite these advances, the disease remains essentially incurable with standard therapy, and novel approaches to treatment are needed because optimal therapy is not defined. The combination of chlorambucil-rituximab is one of several standard treatment options for FL. Here, we considered data arising from 75 patients with newly diagnosed FL at the European Institute of Oncology treated with the combination of rituximab plus chlorambucil. The aim of this study was to evaluate the efficacy and safety of chlorambucil and rituximab, delivered 6mg/m2/day orally for 6weeks and 375mg/m2 in a standard 4-weekly schedule, respectively. Patients responding to the induction therapy received a prolonged therapy with four additional cycles of chlorambucil plus rituximab. Seventy-one patients (94.6{\%}) completed the treatment; four patients discontinued treatment because of grade 3-4 hematological toxicity. The overall response rate was 97.3{\%} including 74.7{\%} of complete responses. Only two patients had a stable disease at revaluation after treatment. With a median follow-up of 57months, 72 patients (96{\%}) are alive. Median event-free survival (EFS) and median overall survival (OS) were not reached; 5-year OS rate was 98.4{\%}. The 5-year EFS was 71.3{\%}. By univariate and multivariate analyses, elevated beta-2 microglobulin levels and partial responses to therapy were correlated with worse EFS. These results suggest that the combination of chlorambucil and rituximab is an active and safe regimen in patients with newly diagnosed FL, principally in those with low tumour burden and favourable prognostic factors.",
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T1 - Chlorambucil-rituximab as first-line therapy in patients affected by follicular non-Hodgkin's lymphoma

T2 - A retrospective single-centre study

AU - Martinelli, Giovanni

AU - Montoro, Juan

AU - Vanazzi, Anna

AU - Andreola, Giovanna

AU - Liptrott, Sarah

AU - Radice, Davide

AU - Negri, Mara

AU - Preda, Lorenzo

AU - Pruneri, Giancarlo

AU - Laszlo, Daniele

PY - 2015/12/1

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AB - Rituximab, a chimeric monoclonal antibody directed against the CD20 antigen, has been shown to be active in newly diagnosed and relapsed patients with follicular lymphoma (FL), both as monotherapy and in combination with chemotherapy. Many studies suggest that the prognosis of patients with FL may improve when it is used in combination with chemotherapy. Despite these advances, the disease remains essentially incurable with standard therapy, and novel approaches to treatment are needed because optimal therapy is not defined. The combination of chlorambucil-rituximab is one of several standard treatment options for FL. Here, we considered data arising from 75 patients with newly diagnosed FL at the European Institute of Oncology treated with the combination of rituximab plus chlorambucil. The aim of this study was to evaluate the efficacy and safety of chlorambucil and rituximab, delivered 6mg/m2/day orally for 6weeks and 375mg/m2 in a standard 4-weekly schedule, respectively. Patients responding to the induction therapy received a prolonged therapy with four additional cycles of chlorambucil plus rituximab. Seventy-one patients (94.6%) completed the treatment; four patients discontinued treatment because of grade 3-4 hematological toxicity. The overall response rate was 97.3% including 74.7% of complete responses. Only two patients had a stable disease at revaluation after treatment. With a median follow-up of 57months, 72 patients (96%) are alive. Median event-free survival (EFS) and median overall survival (OS) were not reached; 5-year OS rate was 98.4%. The 5-year EFS was 71.3%. By univariate and multivariate analyses, elevated beta-2 microglobulin levels and partial responses to therapy were correlated with worse EFS. These results suggest that the combination of chlorambucil and rituximab is an active and safe regimen in patients with newly diagnosed FL, principally in those with low tumour burden and favourable prognostic factors.

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