NEW ORLEANS—There was good news at ASH 2009 on promising treatments for indolent lymphoma and aggressive non-Hodgkin's lymphoma. Also, a separate poster presentation showed that even just one cycle of postremission therapy extended survival in elderly patients with acute myeloid leukemia.
Bendamustine/Rituximab for Indolent Lymphoma
Bendamustine (Treanda) plus rituximab(Drug information on rituximab) (Rituxan) was better tolerated and improved progression-free survival (PFS) compared with standard CHOP plus rituximab (CHOP-R) as first-line therapy for indolent lymphoma in a multicenter, randomized, controlled trial conducted by the German Study Group on Indolent Lymphoma (StiL).
“This study is potentially practice-changing,” said Mathias J. Rummel, MD, head of the department of hematology at Hospital of the Justus-Liebig, University of Giessen in Giessen, Germany.
The study included 549 symptomatic patients (splenomegaly, pain, large tumor burden) enrolled at 82 centers, with a median age of 64 years. Patients were randomized to either bendamustine plus rituximab (B/R) or CHOP-R. Of these, 513 patients were evaluable for toxicity and efficacy. Histologies were distributed equally between B/R and CHOP-R:
• 55% had follicular lymphoma
• 18% had mantle cell lymphoma (MCL)
• 27% had other indolent lymphomas
• 56% had follicular lymphoma
• 19% had MCL
• 24% had other indolent lymphomas
MCL is not considered indolent but was included because it is not curable with standard therapy, according to Dr. Rummel's group (abstract 405).
B/R caused significantly less hematologic toxicity (grades 3 and 4 leukocytopenia, neutropenia, and need for growth factor support with granulocyte colony-stimulating factor; P < .0001 for all comparisons). Alopecia did not occur in patients treated with bendamustine, whereas most patients treated with CHOP-R lost their hair. A much smaller percentage of patients in the B/R arm than in the CHOP-R arm experienced paresthesias, stomatitis, skin reactions, infectious complications, and sepsis.
Overall response rate (ORR) was similar for the two regimens: 92.7% for B/R and 91% for CHOP-R. Complete response (CR) occurred in more patients in the B/R arm than in the CHOP-R arm (39.6% vs 30%, respectively), and this translated to significantly better PFS at a median of 54.9 months for B/R vs 34.8 months for CHOP-R (P = .00012). Median follow up in this study thus far is 34 months.