Evaluating long-term outcomes of R-CHOP for advanced follicular lymphoma

This study evaluated the long-term outcomes of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) treatment for previously untreated patients with advanced follicular lymphoma (FL). This study concluded that R-CHOP is effective in patients with newly diagnosed advanced FL.

FL is the second most common type of non-Hodgkin’s lymphoma. Chemoimmunotherapy regimens involving rituximab (Rituxan) remain the standard of care for patients with FL. The most commonly used regimen is R-CHOP.

One of the main goals of treatment is to avoid transformation to more aggressive subtypes. The most common transformation is to diffuse large B-cell lymphoma (DLBCL). The long-term outcomes of R-CHOP treatment for patients with advanced FL remain under investigation.

This study involved 300 patients with previously untreated advanced (stage 3 – 4) FL. All patients received R-CHOP chemoimmunotherapy. Half received 14 cycles and the other half received 21 cycles of treatment. Patients were followed-up for an average of 11.2 years.

10-year progression-free survival (patients still alive 10 years later without tumor growth or spread) was similar for 14 cycles (39%) versus 21 cycles of treatment (33%). 10-year overall survival (patients still alive 10 years later) was also comparable for 14 cycles (85%) versus 21 cycles of treatment (81%). 

Severe infections were higher in patients who received 21 cycles of treatment (23%) compared to 14 cycles (12%). At 5 years, 3.2% of patients experienced lymphoma transformation. At 10 years, this rate was 9.3%. 8.1% of patients developed secondary cancer at 10 years.

This study concluded that R-CHOP is effective in patients with newly diagnosed advanced FL. The authors suggest caution for the risk of late side effects associated with this treatment.

This study involved Japanese patients, so these results may not be applicable to all patients. Also, not all patients with transformed disease had their diagnosis confirmed by laboratory testing. The number of patients with transformed disease may be underestimated.