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First‐line R‐CVP versus R‐CHOP induction immunochemotherapy for indolent lymphoma with rituximab maintenance. A multicentre, phase III randomized study by the Polish Lymphoma Research Group PLRG4

R‐CVP (cyclophosphamide, vincristine, prednisone) and R‐CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone + rituximab) are immunochemotherapy regimens frequently used for remission induction of indolent non‐Hodgkin lymphomas (iNHLs). Rituximab maintenance (RM) significantly improves progr...

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Autores principales: Walewski, Jan, Paszkiewicz‐Kozik, Ewa, Michalski, Wojciech, Rymkiewicz, Grzegorz, Szpila, Tomasz, Butrym, Aleksandra, Giza, Agnieszka, Zaucha, Jan M., Kalinka‐Warzocha, Ewa, Wieczorkiewicz, Agata, Zimowska‐Curyło, Dagmara, Knopińska‐Posłuszny, Wanda, Tyczyńska, Agata, Romejko‐Jarosińska, Joanna, Dąbrowska‐Iwanicka, Anna, Gruszecka, Beata, Jamrozek‐Jedlińska, Maria, Borawska, Anna, Hołda, Waldemar, Porowska, Agnieszka, Romanowicz, Agnieszka, Hellmann, Andrzej, Stella‐Hołowiecka, Beata, Deptała, Andrzej, Jurczak, Wojciech
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154735/
https://www.ncbi.nlm.nih.gov/pubmed/31792945
http://dx.doi.org/10.1111/bjh.16264
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author Walewski, Jan
Paszkiewicz‐Kozik, Ewa
Michalski, Wojciech
Rymkiewicz, Grzegorz
Szpila, Tomasz
Butrym, Aleksandra
Giza, Agnieszka
Zaucha, Jan M.
Kalinka‐Warzocha, Ewa
Wieczorkiewicz, Agata
Zimowska‐Curyło, Dagmara
Knopińska‐Posłuszny, Wanda
Tyczyńska, Agata
Romejko‐Jarosińska, Joanna
Dąbrowska‐Iwanicka, Anna
Gruszecka, Beata
Jamrozek‐Jedlińska, Maria
Borawska, Anna
Hołda, Waldemar
Porowska, Agnieszka
Romanowicz, Agnieszka
Hellmann, Andrzej
Stella‐Hołowiecka, Beata
Deptała, Andrzej
Jurczak, Wojciech
author_facet Walewski, Jan
Paszkiewicz‐Kozik, Ewa
Michalski, Wojciech
Rymkiewicz, Grzegorz
Szpila, Tomasz
Butrym, Aleksandra
Giza, Agnieszka
Zaucha, Jan M.
Kalinka‐Warzocha, Ewa
Wieczorkiewicz, Agata
Zimowska‐Curyło, Dagmara
Knopińska‐Posłuszny, Wanda
Tyczyńska, Agata
Romejko‐Jarosińska, Joanna
Dąbrowska‐Iwanicka, Anna
Gruszecka, Beata
Jamrozek‐Jedlińska, Maria
Borawska, Anna
Hołda, Waldemar
Porowska, Agnieszka
Romanowicz, Agnieszka
Hellmann, Andrzej
Stella‐Hołowiecka, Beata
Deptała, Andrzej
Jurczak, Wojciech
author_sort Walewski, Jan
collection PubMed
description R‐CVP (cyclophosphamide, vincristine, prednisone) and R‐CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone + rituximab) are immunochemotherapy regimens frequently used for remission induction of indolent non‐Hodgkin lymphomas (iNHLs). Rituximab maintenance (RM) significantly improves progression‐free survival (PFS) in patients with complete/partial remission (CR/PR). Here we report the final results of a randomized study comparing R‐CVP to R‐CHOP both followed by RM. Untreated patients in need of systemic therapy with symptomatic and progressive iNHLs including follicular (FL) and marginal zone lymphoma (MZL), mucosa‐associated lymphoid tissue (MALT), small lymphocytic (SLL), and lymphoplasmacytic (LPL) lymphoma were eligible. Patients were randomized to receive R‐CVP or R‐CHOP for eight cycles or until complete response (CR). All patients with CR/PR (partial response) received RM 375 mg/m(2) q 2 months for 12 cycles. Primary endpoint was event‐free survival (EFS). Two‐hundred and fifty patients [FL 42%, MZL/MALT 38%, LPL/ Waldenström Macroglobulinaemia (WM) 11%, SLL 9%] were enrolled and randomized (R‐CHOP: 127, R‐CVP: 123). Median age was 56 years (21–85), 44% were male, 90% were in stage III–IV, 43% of FL patients had a Follicular Lymphoma International Prognostic Index (FLIPI) score ≥3, and 33·4% of all patients had an IPI score ≥3. At the end of induction treatment, the CR/PR rate was 43·6/50·9% and 36·3/60·8% in the R‐CHOP and R‐CVP groups (P = 0·218) respectively. After a median follow‐up of 67, 66, and 70 months, five‐year EFS was 61% vs. 56% (not significant), progression‐free survival (PFS) was 71% vs. 69% (not significant) and overall survival (OS) was 84% vs. 89% in the R‐CHOP vs. the R‐CVP arm respectively. Grade III/IV adverse events (65 vs. 22) occurred in 40 (33·1%) and 18 (15·3%) patients, P = 0·001; neutropenia in 16 (11·6%) and 4 (3·4%) patients, P = 0·017; infection in 14 (10·7%) and 3 (2·5%) patients,; P = 0·011; and a second neoplasm in three versus seven patients., in the R‐CHOP and the R‐CVP groups respectively. This multicentre randomized study with >five‐year follow‐up shows similar outcome in patients with indolent lymphoma in need of systemic therapy treated with R‐CVP or R‐CHOP immunochemotherapy and rituximab maintenance in both arms. The minor toxicity of the R‐CVP regimen makes it a reasonable choice for induction treatment, leaving other active agents like doxorubicin or bendamustin for second‐line therapy.
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spelling pubmed-71547352020-04-15 First‐line R‐CVP versus R‐CHOP induction immunochemotherapy for indolent lymphoma with rituximab maintenance. A multicentre, phase III randomized study by the Polish Lymphoma Research Group PLRG4 Walewski, Jan Paszkiewicz‐Kozik, Ewa Michalski, Wojciech Rymkiewicz, Grzegorz Szpila, Tomasz Butrym, Aleksandra Giza, Agnieszka Zaucha, Jan M. Kalinka‐Warzocha, Ewa Wieczorkiewicz, Agata Zimowska‐Curyło, Dagmara Knopińska‐Posłuszny, Wanda Tyczyńska, Agata Romejko‐Jarosińska, Joanna Dąbrowska‐Iwanicka, Anna Gruszecka, Beata Jamrozek‐Jedlińska, Maria Borawska, Anna Hołda, Waldemar Porowska, Agnieszka Romanowicz, Agnieszka Hellmann, Andrzej Stella‐Hołowiecka, Beata Deptała, Andrzej Jurczak, Wojciech Br J Haematol Haematological Malignancy – Clinical R‐CVP (cyclophosphamide, vincristine, prednisone) and R‐CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone + rituximab) are immunochemotherapy regimens frequently used for remission induction of indolent non‐Hodgkin lymphomas (iNHLs). Rituximab maintenance (RM) significantly improves progression‐free survival (PFS) in patients with complete/partial remission (CR/PR). Here we report the final results of a randomized study comparing R‐CVP to R‐CHOP both followed by RM. Untreated patients in need of systemic therapy with symptomatic and progressive iNHLs including follicular (FL) and marginal zone lymphoma (MZL), mucosa‐associated lymphoid tissue (MALT), small lymphocytic (SLL), and lymphoplasmacytic (LPL) lymphoma were eligible. Patients were randomized to receive R‐CVP or R‐CHOP for eight cycles or until complete response (CR). All patients with CR/PR (partial response) received RM 375 mg/m(2) q 2 months for 12 cycles. Primary endpoint was event‐free survival (EFS). Two‐hundred and fifty patients [FL 42%, MZL/MALT 38%, LPL/ Waldenström Macroglobulinaemia (WM) 11%, SLL 9%] were enrolled and randomized (R‐CHOP: 127, R‐CVP: 123). Median age was 56 years (21–85), 44% were male, 90% were in stage III–IV, 43% of FL patients had a Follicular Lymphoma International Prognostic Index (FLIPI) score ≥3, and 33·4% of all patients had an IPI score ≥3. At the end of induction treatment, the CR/PR rate was 43·6/50·9% and 36·3/60·8% in the R‐CHOP and R‐CVP groups (P = 0·218) respectively. After a median follow‐up of 67, 66, and 70 months, five‐year EFS was 61% vs. 56% (not significant), progression‐free survival (PFS) was 71% vs. 69% (not significant) and overall survival (OS) was 84% vs. 89% in the R‐CHOP vs. the R‐CVP arm respectively. Grade III/IV adverse events (65 vs. 22) occurred in 40 (33·1%) and 18 (15·3%) patients, P = 0·001; neutropenia in 16 (11·6%) and 4 (3·4%) patients, P = 0·017; infection in 14 (10·7%) and 3 (2·5%) patients,; P = 0·011; and a second neoplasm in three versus seven patients., in the R‐CHOP and the R‐CVP groups respectively. This multicentre randomized study with >five‐year follow‐up shows similar outcome in patients with indolent lymphoma in need of systemic therapy treated with R‐CVP or R‐CHOP immunochemotherapy and rituximab maintenance in both arms. The minor toxicity of the R‐CVP regimen makes it a reasonable choice for induction treatment, leaving other active agents like doxorubicin or bendamustin for second‐line therapy. John Wiley and Sons Inc. 2019-12-02 2020-03 /pmc/articles/PMC7154735/ /pubmed/31792945 http://dx.doi.org/10.1111/bjh.16264 Text en © 2019 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Haematological Malignancy – Clinical
Walewski, Jan
Paszkiewicz‐Kozik, Ewa
Michalski, Wojciech
Rymkiewicz, Grzegorz
Szpila, Tomasz
Butrym, Aleksandra
Giza, Agnieszka
Zaucha, Jan M.
Kalinka‐Warzocha, Ewa
Wieczorkiewicz, Agata
Zimowska‐Curyło, Dagmara
Knopińska‐Posłuszny, Wanda
Tyczyńska, Agata
Romejko‐Jarosińska, Joanna
Dąbrowska‐Iwanicka, Anna
Gruszecka, Beata
Jamrozek‐Jedlińska, Maria
Borawska, Anna
Hołda, Waldemar
Porowska, Agnieszka
Romanowicz, Agnieszka
Hellmann, Andrzej
Stella‐Hołowiecka, Beata
Deptała, Andrzej
Jurczak, Wojciech
First‐line R‐CVP versus R‐CHOP induction immunochemotherapy for indolent lymphoma with rituximab maintenance. A multicentre, phase III randomized study by the Polish Lymphoma Research Group PLRG4
title First‐line R‐CVP versus R‐CHOP induction immunochemotherapy for indolent lymphoma with rituximab maintenance. A multicentre, phase III randomized study by the Polish Lymphoma Research Group PLRG4
title_full First‐line R‐CVP versus R‐CHOP induction immunochemotherapy for indolent lymphoma with rituximab maintenance. A multicentre, phase III randomized study by the Polish Lymphoma Research Group PLRG4
title_fullStr First‐line R‐CVP versus R‐CHOP induction immunochemotherapy for indolent lymphoma with rituximab maintenance. A multicentre, phase III randomized study by the Polish Lymphoma Research Group PLRG4
title_full_unstemmed First‐line R‐CVP versus R‐CHOP induction immunochemotherapy for indolent lymphoma with rituximab maintenance. A multicentre, phase III randomized study by the Polish Lymphoma Research Group PLRG4
title_short First‐line R‐CVP versus R‐CHOP induction immunochemotherapy for indolent lymphoma with rituximab maintenance. A multicentre, phase III randomized study by the Polish Lymphoma Research Group PLRG4
title_sort first‐line r‐cvp versus r‐chop induction immunochemotherapy for indolent lymphoma with rituximab maintenance. a multicentre, phase iii randomized study by the polish lymphoma research group plrg4
topic Haematological Malignancy – Clinical
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154735/
https://www.ncbi.nlm.nih.gov/pubmed/31792945
http://dx.doi.org/10.1111/bjh.16264
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