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Long-Term Remissions of Patients With Follicular Lymphoma Grade 3 Treated With R-CHOP
Paolo Strati1, Nathan Fowler2, Sergio Pina-Oviedo3
1Department of Cancer Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX.
Background:
The optimal management of patients with follicular lymphoma Grade 3 (FLG3) is controversial.
Patients And Methods:
This is a case series of 45 patients with FLG3 treated with first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and observed for an extended time interval.
Results:
The overall response rate was 100% and the median progression-free survival (PFS) has not been reached, with a 3-year PFS of 70%; 14 (31%) patients relapsed, nearly all within 3 years. The baseline characteristic more strongly associated with a shorter PFS were lymph >4 node sites and presence of B symptoms. Three patients later progressed to diffuse large B cell lymphoma, all had baseline elevated serum lactate dehydrogenase level and high International Prognostic Index score. Median overall survival has not been reached. All 4 patients who later developed acute myeloid leukemia were older than 60 years at the time of start of therapy.
Conclusion:
R-CHOP is an effective first-line treatment for patients with FLG3, and might provide extended PFS, comparable with outcomes observed in diffuse large B-cell lymphoma, particularly in subgroups with limited nodal disease.
