R-CHOP treatment for patients with advanced follicular lymphoma: Over 15-year follow-up of JCOG0203

Br J Haematol. 2024 Mar;204(3):849-860. doi: 10.1111/bjh.19213. Epub 2023 Nov 23.

Abstract

Anti-CD20 antibody in combination with chemotherapy extends overall survival (OS) in untreated advanced-stage follicular lymphoma (FL), yet the optimal associated therapy is unclear. Data on the cumulative incidence of secondary malignancies postrelapse after conventional immunochemotherapy are scarce. A long-term analysis of rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) as first-line treatment was conducted in a randomised clinical trial. A six-cycle R-CHOP regimen was administered every 2 or 3 weeks without rituximab maintenance. A prespecified evaluation was conducted 15 years after the completion of enrolment, following initial analysis results that showed no significant differences in outcomes at the 3-year mark. In-depth analyses were performed on the cohort of 248 patients with FL who were allocated to the two treatment arms. With a median follow-up period of 15.9 years, the 15-year OS was 76.2%. There were no protocol treatment-related deaths, nor were there any fatal infections attributable to subsequent lymphoma treatment. At 15 years, the cumulative incidence of non-haematological and haematological malignancies was 12.8% and 3.7% respectively. Histological transformation appeared after a median of 8 years. R-CHOP maintains safety and efficacy in patients with advanced FL over extended follow-up, making it a viable first-line option for patients with advanced-stage FL.

Keywords: R-CHOP; follicular lymphoma; histological transformation; long term; secondary malignancies.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cyclophosphamide
  • Doxorubicin
  • Follow-Up Studies
  • Humans
  • Lymphoma, Follicular* / drug therapy
  • Prednisone
  • Rituximab
  • Treatment Outcome
  • Vincristine

Substances

  • Rituximab
  • Vincristine
  • Prednisone
  • Antibodies, Monoclonal, Murine-Derived
  • Cyclophosphamide
  • Doxorubicin