How effective is rituximab, bendamustine, mitoxantrone (R-BM) and rituximab consolidation as a treatment regimen for elderly patients with advanced follicular lymphoma?

This study aimed to investigate if rituximab (Rituxan), bendamustine (Treanda), and mitoxantrone (Novantrone) or R-BM followed by rituximab consolidation was a safe and effective treatment in older patients with follicular lymphoma (FL).

The authors concluded that this treatment provided durable responses and was well tolerated in these patients.

FL is a common cancer of mature adults and elderly people, with an average age of 65 years. Chemoimmunotherapy (CIT) including rituximab is an effective treatment option for FL. However, there is still no clear evidence of an appropriate chemotherapy regimen to combine with immunotherapy, especially in elderly patients. Regimens involving fludarabine (Fludara) are known to be toxic to FL patients. Therefore, bendamustine might be a more appropriate chemotherapy for older patients.

Rituximab immunotherapy may also be given as consolidation (treatment meant to kill any cancer cells left after primary treatment) or maintenance therapy (treatment meant to prevent or delay relapse after remission). In a previous study, maintenance rituximab did not significantly improve survival without cancer worsening.

The safety and effectiveness of CIT containing rituximab, bendamustine, and mitoxantrone (R-BM) followed by rituximab consolidation therapy remain under investigation.

The trial recruited 76 patients aged 65-80 that had FL. Patients were given 4 monthly courses of R-BM. 4 weeks after R-BM was given, tumor response to the treatment was assessed. Those in complete remission (CR; complete disappearance of all signs of cancer) or partial remission (PR; the extent of the cancer decreased) or with a stable disease (SD; cancer is neither growing nor shrinking) were given 4-weekly doses of rituximab consolidation. Patients were followed up for an average of 44 months.

After R-BM treatment, 42% of patients experienced CR, 53% PR and 5% SD. At the end of the trial, 78% of patients experienced CR, 16% PR, and 6% PD. 70% of patients in PR after R-BM had CR after rituximab consolidation.

67% were alive without cancer worsening after 3 years and 92% were alive after 3 years.

Low levels of white blood cells was a common severe side effect, reported in 18% of patients. 

The authors concluded that a short course of R-BM followed by rituximab consolidation was a safe, effective and suitable treatment regimen for elderly patients with FL.

This study had a small number of participants. Also, there was no comparison treatment group. Further trials are needed.