Is R-FND and ibritumomab tiuxetan an appropriate treatment for untreated high-risk follicular lymphoma?

This trial was carried out to assess the effectiveness R-FND (rituximab, fludarabine, mitoxantrone, and dexamethasone) followed by ibritumomab tiuxetan (YIT; Zevalin) radioimmunotherapy (RIT), and rituximab maintenance therapy in patients with untreated high-risk follicular lymphoma (FL). The authors found that this treatment is appropriate for patients with high-risk FL. 

FL is a type of non-Hodgkin lymphoma (NHL). Induction therapy is the first treatment given for a disease. It usually has poor results in patients with advanced FL. Other therapies are needed for these patients. Maintenance therapy is given after induction therapy to keep the cancer from coming back.

Immunotherapies such as rituximab (R; Rituximab) have improved the outcomes of patients with advanced FL. FND chemotherapy combined with rituximab has shown good responses in patients with advanced FL. YIT is an immune therapy that is combined with a radioactive substance that delivers radiation directly to the targeted cancer cells. 

Until now, the use of R-FND, YIT, and R-maintenance therapy has not been examined in patients with high-risk FL. 

There were 47 patients with advanced FL who received treatment in this trial. The average follow-up for this trial was 117 months. 38 patients received YIT therapy. 41 received maintenance treatment with rituximab.

91.3% of participants had a complete response (CR) after 4 cycles of R-FND. The other 8.7% had a partial response (PR). After YIT, 97.4% of patients achieved a CR.

The average survival without cancer worsening was 84 months. 49% of participants had not had cancer progression at 10-years. The average overall survival of patients was 143 months. 69% of patients were alive at 10 years follow-up. 

Most side effects involved low blood cell counts. 10.6% of participants developed a new cancer after an average period of 55 months from R-FND.

The authors concluded that in patients with high-risk FL R-FND, YIT, and rituximab maintenance therapy was an appropriate treatment.

This trial was sponsored by Genentech, the manufacturers of rituximab. This trial had a small number of participants and did not have a control group for comparison.