The use of anthracycline at first-line compared to alkylating agents or nucleoside analogs improves the outcome of salvage treatments after relapse in follicular lymphoma The REFOLL study by the Fondazione Italiana Linfomi

Giuseppe Rossi, Luigi Marcheselli, Alessandra Dondi, Chiara Bottelli, Alessandra Tucci, Stefano Luminari, Luca Arcaini, Michele Merli, Alessandro Pulsoni, Carola Boccomini, Benedetta Puccini, Moira Micheletti, Giovanni Martinelli, Andrea Rossi, Vittorio Ruggero Zilioli, Valentina Bozzoli, Monica Balzarotti, Silvia Bolis, Maria Giuseppina Cabras, Massimo Federico

Research output: Contribution to journalArticle

Abstract

Follicular lymphoma (FL) patients experience multiple remissions and relapses and commonly receive multiple treatment lines. A crucial question is whether anthracyclines should be used at first-line or whether they would be better "reserved" for relapse and whether FL outcome can be optimized by definite sequences of treatments. Randomized trials can be hardly designed to address this question. In this retrospective multi-institutional study, time-to-next-treatment after first relapse was analyzed in 510 patients who had received either alkylating agents- or anthracycline- or nucleoside analogs-based chemotherapy with/without rituximab at first-line and different second-line therapies. After a median of 42 months, median time-to-next-treatment after relapse was 41 months (CI95%:34-47 months). After adjustment for covariates, first-line anthracycline-based chemotherapy with/without rituximab was associated with better time-to-next-treatment after any salvage than alkylating agents-based chemotherapy with/without rituximab or nucleoside analogs-based chemotherapy with/without rituximab (HR:0.74, P=0.027). The addition of rituximab to first-line chemotherapy had no significant impact (HR:1.22, P=0.140). Autologs stem cell transplantation performed better than any other salvage treatment (HR:0.53, P

Original languageEnglish
Pages (from-to)56-61
Number of pages6
JournalAmerican Journal of Hematology
Volume90
Issue number1
DOIs
Publication statusPublished - Jan 1 2015

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

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    Rossi, G., Marcheselli, L., Dondi, A., Bottelli, C., Tucci, A., Luminari, S., Arcaini, L., Merli, M., Pulsoni, A., Boccomini, C., Puccini, B., Micheletti, M., Martinelli, G., Rossi, A., Zilioli, V. R., Bozzoli, V., Balzarotti, M., Bolis, S., Cabras, M. G., & Federico, M. (2015). The use of anthracycline at first-line compared to alkylating agents or nucleoside analogs improves the outcome of salvage treatments after relapse in follicular lymphoma The REFOLL study by the Fondazione Italiana Linfomi. American Journal of Hematology, 90(1), 56-61. https://doi.org/10.1002/ajh.23872