Nastoupil LJ, Sinha R, Byrtek M, Ziemiecki R, Taylor M, Friedberg JW, Koff JL, Link BK, Cerhan JR, Dawson KL, Flowers CR. Comparison of the effectiveness of frontline chemoimmunotherapy regimens for follicular lymphoma used in the United States. Leuk Lymphoma. 2015 May;56(5):1295-302. doi: 10.3109/10428194.2014.953144

Abstract: To compare the effectiveness of frontline rituximab-chemotherapy regimens in clinical practice, we examined outcomes for patients with low-grade, stage III/IV follicular lymphoma receiving rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP); rituximab with cyclophosphamide, vincristine and prednisone (R-CVP); or rituximab with a fludarabine-based regimen (R-Flu) as frontline therapy. In total, 611 patients meeting these criteria were identified in the National LymphoCare Study: 47% receiving R-CHOP (n=287), 31% receiving R-CVP (n=187) and 22% receiving R-Flu (n=137). Overall response rates were high (R-CVP 87%, R-CHOP 93%, R-Flu 94%; p=0.017). Median follow-up was 7.4 years. R-CVP was associated with lower 5-year overall survival (R-CVP 76%, R-CHOP 86%, R-Flu 86%; p=0.021) and progression-free survival (R-CVP 49%, R-CHOP 58%, R-Flu 64%; p=0.029). There were no significant differences in survival in Cox models adjusted for baseline clinical factors, practice region/setting and post-treatment rituximab maintenance/observation.

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