Is R-CHOP chemotherapy an effective first-line treatment for patients with grade 3 follicular lymphoma?

Posted by Medivizor on Jan 7, 2018 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

This study analyzed the long-term outcomes of patients with grade 3 follicular lymphoma (FLG3) who received first-line R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). The study concluded that this regimen is an effective first-line treatment for patients with FLG3, especially in those with less than 4 involved lymph nodes.

Some background

Follicular lymphoma (FL) is the most common type of non-Hodgkin’s lymphoma (NHL), comprising 20% of all lymphomas. In 2016, 14,000 new cases were diagnosed in the U.S. FL is classified into 3 grades, based on the number of lymphoma cells present. 30% of all FL cases are grade 3. Grade 3 FL (FLG3) is further divided into grade 3a (similar to lower FL grades) or 3b (similar to diffuse large B-cell lymphoma, DLBCL).

The optimal treatment for FLG3 is not yet clear. Prior studies have shown R-CHOP to be effective in the short-term. The long-term outcomes with this treatment are still under investigation.

Methods & findings

This study involved 45 patients: 28% with grade 3a disease and 27% grade 3b disease (44% were not classified). All patients received R-CHOP treatment. 20% of patients also received radiotherapy to kill any remaining cancer cells. 66% of these patients had advanced stage disease. Patients were followed for an average of 9 years.

The overall response rate was 100%, with 96% of patients showing complete remission (no sign of active disease) and 4% showing shrinkage of their tumors. After 9 years, 31% of patients had their cancer return. 93% of these relapsed in the first 3 years. 21% of relapsed patients progressed to DLBCL.

70% of patients were progression free at 3 years. Having more than 4 involved lymph nodes was associated with a 5.6-fold higher risk of disease progression. The presence of B symptoms (weight loss, fatigue, night sweats) was associated with a 6.1-fold increase in risk. Four patients developed acute myeloid leukemia following treatment. These patients were all over the age of 60.

The bottom line

This study concluded that R-CHOP is an effective first-line treatment for patients with FLG3, especially in those who have fewer than 4 involved lymph nodes.

The fine print

The current study only included 45 patients out of 156 patients with FLG3, most of whom had grade 3b disease (27%). Comparing this study to other follicular lymphoma clinical trials has its limitations. The dosage schedule of rituximab (Rituxan) can vary between studies, and accurate classification of patients with grade 3a vs. 3b disease can be challenging.

What’s next?

If you have been diagnosed with grade 3 follicular lymphoma, talk to your care team about the R-CHOP regimen. If you are 60 years or older, less aggressive treatments should be considered due to risk of developing acute myeloid leukemia.

Published By :

Clinical lymphoma, myeloma & leukemia

Date :

Nov 14, 2017

Original Title :

Long-Term Remissions of Patients With Follicular Lymphoma Grade 3 Treated With R-CHOP.

Tags: Current stage-Stage III (Advanced), Library Item, Research, Treatment, Type of non Hodgkin's lymphoma-Follicular lymphoma