CHVP + Interferon-Alfa-2b Treatment Is Associated With a Longer Survival Than Fludarabine Alone in Elderly Patients With High-Risk Follicular Lymphoma: A Randomized Study From the GELA

OncologyONCOLOGY Vol 13 No 3
Volume 13
Issue 3

From July 1994 until March 1998, 131 patients with follicular lymphoma, all grades, were randomized between 12 courses of


From July 1994 until March 1998, 131 patients with follicular lymphoma, all grades, were randomized between 12 courses of CHVP (cyclophophamide, doxorubicin, VP-26, and prednisone) + 18 months of interferon-alfa-2b (Intron A), 5 MU three times weekly (arm A; 70 patients) or fludarabine (Fludara), 12 courses of 5 days in 18 months (arm B; 61 patients). All patients were older than 60 years and had a high tumor burden, defined as at least one of the following parameters: poor performance status, high lactic dehydrogenase (LDH) or beta-2-microglobulin levels, lymph node tumor > 7 cm, serous localization, huge splenomegaly, or compressive syndrome.

All analyses were done on an intent-to-treat basis, with 11 patients having a nonfollicular indolent lymphoma after centralized review. Twelve percent of patients had follicular large cell lymphoma; 66%, bone marrow infiltration; 66%, a tumor mass > 7 cm; 13%, a performance status > 1; 28%, B-symptoms; 43%, high LDH; 61%, high beta-2-microglobulin levels; and 77%, more than one criterion of adverse prognosis. No statistical difference existed between the two arms with respect to clinical or biological parameters, as well as parameters defining aggressive disease.

Three patients died during treatment, two in arm A and one in arm B. More toxic events were observed in arm A: 26% of courses with grade 3-4 neutropenia, compared to 5% in arm B, with < 1% of courses with grade 3-4 infection in both arms. In arm A, 22 patients stopped interferon and 8 had a dose reduction because of adverse events (43% of the patients).

After 6 months, 71% and 59% of patients in arms A and B, respectively, responded, and 21% and 39% progressed (P = .005). At 18 months, 19 patients were not analyzable for response (treatment not yet finished), 57% and 39% of patients in arms A and B, respectively, reached a complete response (CR)/partial response (PR), and 36% and 52% progressed (not significant). With a median follow-up of 25 months, time to progression and survival were significantly shorter in arm B (P = .02 and P = .04, respectively) with a 2-year survival of 81% vs 59% in arms A and B, respectively.

In a multiparametric analysis, only the number of adverse criteria and the treatment were statistically associated with survival. Results were identical if only follicular lymphoma patients were analyzed.

CONCLUSION: These results confirmed the good outcome of patients treated with CHVP + interferon and showed that this combination is associated with a longer survival than fludarabine alone in elderly patients with high-risk follicular lymphoma.

Click here for Dr. Bruce Cheson’s commentary on this abstract.

Articles in this issue

WHO Declares Lymphatic Mapping to Be the Standard of Care for Melanoma
Rituximab: Phase II Retreatment Study in Patients With Low-Grade or Follicular Non-Hodgkin’s Lymphoma
Response Criteria for NHL: Importance of “Normal” Lymph Node Size and Correlations With Response
Chemotherapy Plus Radiation Improves Survival in Patients With Cervical Cancer
A Randomized Trial of Fludarabine, Mitoxantrone (FM) Versus Doxorubicin, Cyclophosphamide, Vindesine, Prednisone (CHEP) as First Line Treatment in Patients With Advanced Low-Grade Non-Hodgkin's Lymphoma: A Multicenter Study by GOELAMS Group
Navelbine Increased Elderly Lung Cancer Patients’ Survival
Fludarabine Versus Conventional CVP Chemotherapy in Newly C Diagnosed Patients With Stages III and IV Low-Grade Malignant Non-Hodgkin’s Lymphoma: Preliminary Results From a Prospective, Randomized Phase III Clinical Trial in 381 Patients
Multicenter, Phase III Study of Iodine-131 Tositumomab (Anti-B1 Antibody) for Chemotherapy-Refractory Low-Grade or Transformed Low-Grade Non-Hodgkin’s Lymphoma
T-Cell–Depleted Allogeneic Bone Marrow Transplant From HLA-Matched Sibling Donors for Non-Hodgkin’s Lymphoma
Consensus Statement on Prevention and Early Diagnosis of Lung Cancer
In Vivo Purging and Adjuvant Immunotherapy With Rituximab During PBSC Transplant For NHL
Fludarabine and Cyclophosphamide: A Highly Active and Well-Tolerated Regimen for Patients With Previously Untreated Indolent Lymphomas
Campath-1H Monoclonal Antibody in Therapy for Advanced Low-Grade Non-Hodgkin’s Lymphomas: A Phase II Study
AIDS Drugs Effective Against Most Common HIV Strain
Rituximab Therapy in Previously Treated Waldenström’s Macroglobulinemia: Preliminary Evidence of Activity
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