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Press OW , Unger JM , Rimsza LM , Friedberg JW , LeBlanc M , Czuczman MS , Kaminski M , Braziel RM , Spier C , Gopal AK , Maloney DG , Cheson BD , Dakhil SR , Miller TP , Fisher RI
A Comparative Analysis of Prognostic Factor Models for Follicular Lymphoma Based on a Phase III Trial of CHOP-Rituximab versus CHOP+(131)Iodine-Tositumomab
Clinical Cancer Research. 2013 Dec;19(23) :6624-6632
PMID: WOS:000327819700031    PMCID: PMC 3872052   
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Abstract
There is currently no consensus on optimal frontline therapy for patients with follicular lymphoma. We analyzed a phase III randomized intergroup trial comparing six cycles of CHOP-R (cyclophosphamide-Adriamycin-vincristine-prednisone (Oncovin)-rituximab) with six cycles of CHOP followed by iodine-131 tositumomab radioimmunotherapy (RIT) to assess whether any subsets benefited more from one treatment or the other, and to compare three prognostic models. Experimental Design: Weconducted univariate and multivariate Cox regression analyses of 532 patients enrolled on this trial and compared the prognostic value of the FLIPI (follicular lymphoma international prognostic index), FLIPI2, and LDH + beta 2M (lactate dehydrogenase + beta 2-microglobulin) models. Results: Outcomes were excellent, but not statistically different between the two study arms [5-year progression-free survival (PFS) of 60% with CHOP-R and 66% with CHOP-RIT (P 0.11); 5-year overall survival (OS) of 92% with CHOP-R and 86% with CHOP-RIT (P 0.08); overall response rate of 84% for both arms]. The only factor found to potentially predict the impact of treatment was serum beta 2M; among patients with normal beta 2M, CHOP-RIT patients had better PFS compared with CHOP-R patients, whereas among patients with high serum beta 2M, PFS by arm was similar (interaction P value 0.02). Conclusions: All three prognostic models (FLIPI, FLIPI2, and LDH + beta 2M) predicted both PFS and OS well, though the LDH + beta 2M model is easiest to apply and identified an especially poor risk subset. In an exploratory analysis using the latter model, there was a statistically significant trend suggesting that low-risk patients had superior observed PFS if treated with CHOP-RIT, whereas high-risk patients had a better PFS with CHOP-R. Clin Cancer Res; 19(23); 6624-32. (C) 2013 AACR.
Notes
Press, Oliver W. Unger, Joseph M. Rimsza, Lisa M. Friedberg, Jonathan W. LeBlanc, Michael Czuczman, Myron S. Kaminski, Mark Braziel, Rita M. Spier, Catherine Gopal, Ajay K. Maloney, David G. Cheson, Bruce D. Dakhil, Shaker R. Miller, Thomas P. Fisher, Richard I.