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Obinutuzumab versus rituximab-based chemotherapy in high-tumor burden indolent B-cell lymphoma: a real-world
Xin Wan1, Dechuan Liu2, Haotian Wang1
1Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, China.
Background:
Patients with previously untreated follicular lymphoma (FL) or marginal zone lymphoma (MZL) with high-tumor burden represent a subset with unfavorable prognosis. However, the efficacy of obinutuzumab in this specific high-risk population remains incompletely characterized. This study aimed to compare the efficacy and safety of obinutuzumab-based versus rituximab-based chemotherapy in patients with high-risk features of FL and MZL.
Methods:
A retrospective analysis was conducted on 186 patients with histologically confirmed FL or MZL who received either obinutuzumab-based (n=92) or rituximab-based (n=94) chemotherapy at the First Hospital of Jilin University from February 2016 to February 2025. A propensity score overlap weight (PSOW) analysis was performed to adjust statistical influences between the two groups. Efficacy evaluation included complete response rate (CRR), objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and progression of disease within 24 months (POD24).
Results:
After induction therapy, the CRR was significantly higher in the obinutuzumab group compared to the rituximab group (82.6% vs. 54.3%, p=0.014). With a median follow-up of 31.5 months, the obinutuzumab group demonstrated superior 3-year PFS (81.4% vs. 62.1%, p=0.0026) and 3-year OS (99.0% vs. 87.3%, p=0.004). The incidence of POD24 was lower in the obinutuzumab group (13.0% vs. 24.5%, p=0.046). Multivariable analysis identified rituximab-based treatment as an independent risk factor for inferior OS (HR 9.6, p=0.026). Safety profiles were similar between the two groups, with no significant differences in adverse event rates.
Conclusion:
Obinutuzumab-based chemotherapy was associated with significantly higher CRR, improved survival outcomes, and a lower POD24 rate compared to rituximab-based chemotherapy in patients with high-tumor burden of FL and MZL. These findings support the preferential use of obinutuzumab in this high-risk population.
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