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Long-Term Follow-up in Follicular Lymphoma: SWOG Phase III Trial Reports Outcomes

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Key Points

  • The 10-year progression-free survival rate was 56% in the CHOP-RIT group vs 42% in the R-CHOP group.
  • The 10-year overall survival rate was 75% vs 81%.

As reported in the Journal of Clinical Oncology by Shadman et al, long-term follow-up of patients with previously untreated advanced-stage follicular lymphoma in the phase III SWOG-S0016 trial has shown continued good outcomes with both R-CHOP (rituximab [Rituxan] plus cyclophosphamide, doxorubicin, vincristine, and prednisone) and CHOP-RIT (CHOP followed by consolidation with iodine-131 tositumomab [Bexxar] radioimmunotherapy).

Key Outcomes

In the trial, 531 eligible patients with stage II, III, or IV bulky disease of any pathologic grade were randomized between 2001 and 2008 to receive R-CHOP (n = 264) or CHOP-RIT (n = 267). After a median follow-up of 10.3 years, estimated 10-year progression-free and overall survival were 49% and 78% among all patients, with a significant difference favoring CHOP-RIT vs R-CHOP in progression-free survival (56% vs 42%, P = .01) but no significant difference in overall survival (75% vs 81%, P = .13).

There were no significant differences between the CHOP-RIT and R-CHOP groups in incidence of second malignancies (15.1% vs 16.1%, P = .81) or myelodysplastic syndrome or acute myeloid leukemia (4.9% vs 1.8%, P = .058). The estimated 10-year cumulative incidence of death from second malignancies was 7.1% vs 3.2% (P = .16) and the cumulative incidence of death from myelodysplastic syndrome or acute myeloid leukemia was 4.0% vs 0.9% (P = .02).

The investigators concluded, “Given these outstanding outcomes, immunochemotherapy should remain the standard induction approach for patients with high-risk [follicular lymphoma] until long-term follow-up of alternative approaches demonstrates superiority.”

The study was supported by grants from the National Cancer Institute and by GlaxoSmithKline.

Mazyar Shadman, MD, MPH, of Fred Hutchinson Cancer Research Center, is the corresponding author for the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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