Published in:
01-08-2021 | Lymphoma | Original Article
Low absolute lymphocyte count is a poor prognostic factor for untreated advanced follicular lymphoma treated with rituximab plus bendamustine: results of the prospective phase 2 CONVERT trial
Authors:
Shinya Rai, Hiroaki Inoue, Hitoshi Hanamoto, Mitsuhiro Matsuda, Yasuhiro Maeda, Yusuke Wada, Takahiro Haeno, Yosaku Watatani, Takahiro Kumode, Chikara Hirase, J. Luis Espinoza, Yasuyoshi Morita, Hirokazu Tanaka, Yoichi Tatsumi, Itaru Matsumura
Published in:
International Journal of Hematology
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Issue 2/2021
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Abstract
The aim of this trial is to evaluate the utility of rituximab–bendamustine (R–B) for untreated advanced follicular lymphoma (FL) showing non-optimal response (nOR) to R-CHOP, and to identify clinical prognostic factors for FL patients receiving R–B. Patients who failed to achieve complete response/complete response unconfirmed (CR/CRu) [nOR-group] after 2 cycles of R-CHOP subsequently received 6 cycles of R–B. The primary endpoint was the 3-year progression-free survival (PFS) rate. Secondary endpoints included determination of prognostic factors. Fifty-six patients initially received R-CHOP, 43/56 patients (76.8%) were judged as nOR, and 33/43 patients (76.7%) completed 6 cycles of R–B. At a median follow-up of 50.6 months in the nOR-group, the 3-year PFS rate was 69.0%, and the 3-year overall survival (OS) rate was 92.7%. The most common toxicities associated with R–B were grade 3–4 lymphopenia (93.0%) and neutropenia (74.4%), both of which were manageable. A multivariate analysis including dose intensity, serum soluble interleukin‐2 receptor, and FL international prognostic index-2 revealed low absolute lymphocyte count (< 869/μL) at diagnosis was an independent poor prognostic factor for both PFS and OS in the R–B-treated nOR-group. This result was further confirmed in validation cohorts including R–B-treated de novo (n = 40) and relapsed (n = 49) FL patients.