Bendamustine plus rituximab versus R-CHOP as first-line treatment for patients with indolent non-Hodgkin’s lymphoma: evidence from a multicenter, retrospective study
- 1.7k Downloads
The optimal first-line treatment for advanced low-grade non-Hodgkin lymphomas (LG-NHL) is still highly debated. Recently, the StiL and the BRIGHT trials showed that the combination of rituximab and bendamustine (R-B) is non-inferior to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with a better toxicity profile. Utilizing a retrospective analysis, we compared the efficacy and safety of both regimens in clinical practice. From November 1995 to January 2014, 263 LG-NHL patients treated with either R-B or R-CHOP were retrospectively assessed in seven European cancer centers. Ninety patients were treated with R-B and 173 with R-CHOP. Overall response rate was 94 and 92 % for the R-B and the R-CHOP group, respectively. The percentage of complete response was similar for both groups (63 vs. 66 % with R-B and R-CHOP, respectively; p = 0.8). R-B was better tolerated and less toxic than R-CHOP. The median follow-up was 6.8 and 5.9 years for the R-CHOP and the R-B group, respectively. Overall, no difference in progression-free survival (PFS) (108 vs. 110 months; p = 0.1) was observed in the R-B group compared to the R-CHOP cohort. Nevertheless, R-B significantly prolonged PFS in FL patients (152 and 132 months in the R-B and R-CHOP group, respectively; p = 0.05). However, this result was not verified in multivariate analysis probably due to the limits of the present study. We confirm that the R-B regimen administered in patients with LG-NHL is an effective and less toxic therapeutic option than R-CHOP in clinical practice.
KeywordsBendamustine R-CHOP Indolent lymphoma First-line therapy Follicular lymphoma
This article did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.
Compliance with ethical standards
This analysis was approved by the local Ethical Committee (Prot. 0042654-BZ). Due to the retrospective and anonymous data collection, informed consent was not necessary.
Conflict of interest
The authors have no conflicts of interest. PM, NS, IW, FZ, RZ, AV, EM, PG, VP, and SC have no financial disclosure. SF and MM have received honoraria from Mundipharma; WW has received honoraria and research funding from Mundipharma and Roche.
- 7.Ruffert K, Jahn H, Syrbe G et al (1989) Bendamustine as an alternative approach to treat malignant non-Hodgkin’s lymphoma. Z Klin Med 8:671–674Google Scholar
- 8.Herold M, Keinert K, Anger G (1992) Risk-adapted combined radiotherapy and chemotherapy for Hodgkin’s disease. Onkologie 15:501–505Google Scholar
- 10.Rummel MJ, Niederle N, Maschmeyer G et al (2013) Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: an open-label, multicentre, randomised, phase 3 non-inferiority trial. Lancet 381:1203–1210CrossRefPubMedGoogle Scholar
- 12.Burke JM, Van der Jagt RH, Kahl BS, et al. (2012) Differences in quality of life between bendamustine plus rituximab compared with standard first- line treatments in patients with previously untreated advanced indolent non-Hodgkin’s lymphoma or mantle cell lymphoma. Blood a155Google Scholar
- 13.Morschhauser F, Seymour JF, Feugier P et al (2011) Impact of induction chemotherapy regimen on response, safety and outcome in the PRIMA study. Ann Oncol 22(suppl 4):89Google Scholar
- 15.Swerdlow SH, Campo E, Harris NL, Swerdlow SH, Campo E, Harris NL (2008) WHO classification of tumours of haematopoietic and lymphoid tissues, 4th edn. IARC Press, LyonGoogle Scholar
- 22.Hiddemann W, Kneba M, Dreyling M et al (2005) Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood 106:3725–3732CrossRefPubMedGoogle Scholar