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Clin Cancer Res. 2013 Dec 1;19(23):6624-32. doi: 10.1158/1078-0432.CCR-13-1120. Epub 2013 Oct 15.

A comparative analysis of prognostic factor models for follicular lymphoma based on a phase III trial of CHOP-rituximab versus CHOP + 131iodine--tositumomab.

Author information

1
Authors' Affiliations: Clinical Research Division; SWOG Statistical Center, Fred Hutchinson Cancer Research Center; Medical Oncology, University of Washington Medical Center, Seattle, Washington; Department of Pathology; Arizona Cancer Center, University of Arizona, Tucson, Arizona; James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester; Roswell Park Cancer Institute, Buffalo, New York; Cancer and Leukemia Group B; University of Michigan, Ann Arbor, Michigan; Department of Pathology, Oregon Health and Science University, Portland, Oregon; Georgetown University Hospital, Washington; Wichita Community Clinical Oncology Program, Wichita, Kansas; and Fox Chase Cancer Center-Temple Health, Temple University, Philadelphia PA.

Abstract

PURPOSE:

There is currently no consensus on optimal frontline therapy for patients with follicular lymphoma. We analyzed a phase III randomized intergroup trial comparing six cycles of CHOP-R (cyclophosphamide-Adriamycin-vincristine-prednisone (Oncovin)-rituximab) with six cycles of CHOP followed by iodine-131 tositumomab radioimmunotherapy (RIT) to assess whether any subsets benefited more from one treatment or the other, and to compare three prognostic models.

EXPERIMENTAL DESIGN:

We conducted univariate and multivariate Cox regression analyses of 532 patients enrolled on this trial and compared the prognostic value of the FLIPI (follicular lymphoma international prognostic index), FLIPI2, and LDH + β2M (lactate dehydrogenase + β2-microglobulin) models.

RESULTS:

Outcomes were excellent, but not statistically different between the two study arms [5-year progression-free survival (PFS) of 60% with CHOP-R and 66% with CHOP-RIT (P = 0.11); 5-year overall survival (OS) of 92% with CHOP-R and 86% with CHOP-RIT (P = 0.08); overall response rate of 84% for both arms]. The only factor found to potentially predict the impact of treatment was serum β2M; among patients with normal β2M, CHOP-RIT patients had better PFS compared with CHOP-R patients, whereas among patients with high serum β2M, PFS by arm was similar (interaction P value = 0.02).

CONCLUSIONS:

All three prognostic models (FLIPI, FLIPI2, and LDH + β2M) predicted both PFS and OS well, though the LDH + β2M model is easiest to apply and identified an especially poor risk subset. In an exploratory analysis using the latter model, there was a statistically significant trend suggesting that low-risk patients had superior observed PFS if treated with CHOP-RIT, whereas high-risk patients had a better PFS with CHOP-R.

PMID:
24130072
PMCID:
PMC3872052
DOI:
10.1158/1078-0432.CCR-13-1120
[Indexed for MEDLINE]
Free PMC Article

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