Does first-line treatment with R-CHOP benefit patients with grade 3A follicular lymphoma?

This study aimed to compare the effectiveness of 2 drug regimens for patients with grade 3A follicular lymphoma (FL3A). The authors concluded that R-CHOP has a benefit over RB in the treatment of these patients.

Follicular lymphoma (FL) is the most common type of non-Hodgkin lymphoma (NHL).FL usually has good outcomes after chemotherapy and immunotherapy. FL is divided into groups according to aggressiveness. Grade 1-2 is considered less aggressive, while 3A and 3B are considered more aggressive.

For FL1-2 and FL3B there are very clear recommendations for treatment. FL1-2 is commonly treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or bendamustine (Treanda) plus rituximab (Rituxan) or obinutuzumab (Gazyva). FL3B is treated as an aggressive NHL with R-CHOP that includes CHOP plus rituximab. However, whether patients with FL3A should be treated as a less aggressive NHL with rituximab–bendamustine (RB) or more aggressively with R-CHOP is still unknown.  

There were 95 patients with FL3A included in this study. 59 patients received R-CHOP and 36 received R-B. Follow-up was 56 months in patients with FL3A.

95% of patients in the R-CHOP group responded to treatment compared to 76% in the R-B group. After 3 years, 87% of patients in the R-CHOP group were estimated to survive compared to 73% in the R-B group. 54% of the R-CHOP group relapsed compared to 51% of the R-B group.

Another analysis included 203 patients with FL1-2. 98 patients were treated with R-CHOP and 105 with R-B. Follow-up was 64 months in patients with FL1-2.

91% of patients treated with R-CHOP and 89% with R-B responded to treatment. The 3-year survival was similar with R-CHOP (91%) and R-B treatment (95%). Patients with FL1-2 had a 68% relapse rate in the R-CHOP group compared to 24% in the R-B group. At 3 years, the R-B had a significantly longer survival rate without cancer worsening (79%) compared to the R-CHOP group (47%).

The authors concluded that in patients with FL3A treated with first-line R-CHOP had significantly longer overall survival as compared to patients treated with R-B. Patients with FL1-2 had longer survival without cancer worsening when treated with R-B.

This study was based on medical records. Information might have been incomplete.