Page 135 - 2019_11 Resto del Mondo-web

Non-Hodgkin Lymphoma
Prolonged survival in the absence of disease-recurrence in advanced-stage follicular lymphoma following chemo-immunotherapy: 13-year update
of the prospective, multicenter randomized GITMO-IIL trial
Ferrata Storti Foundation
Haematologica 2019 Volume 104(11):2241-2248
Riccardo Bruna,1§ Fabio Benedetti,2 Carola Boccomini,3 Caterina Patti,4
Anna Maria Barbui,5 Alessandro Pulsoni,6 Maurizio Musso,7 Anna Marina Liberati,8 Guido Gini,9 Claudia Castellino,10 Fausto Rossini,11 Fabio Ciceri,12
Delia Rota-Scalabrini,13 Caterina Stelitano,14 Francesco Di Raimondo,15
Alessandra Tucci,16 Liliana Devizzi,17 Valerio Zoli,18 Francesco Zallio,19
Franco Narni,20 Alessandra Dondi,21 Guido Parvis,22^ Gianpietro Semenzato,23 Francesco Lanza,24° Tommasina Perrone,25 Francesco Angrilli,26 Atto Billio,27
Angela Gueli,1 Barbara Mantoan,28 Alessandro Rambaldi,5,29 Alessandro Massimo Gianni,1 Paolo Corradini,17,29 Roberto Passera,30 Marco Ladetto,19
Corrado Tarella*1,31
1Onco-Hematology Division, IEO, European Institute of Oncology IRCCS, Milano; 2Hematology University Division, Verona; 3Hematology Division, Città della Salute Hospital, Torino; 4Hematology Division, Azienda Villa Sofia-Cervello, Palermo; 5Hematology Division, Papa Giovanni XXIII Hospital, Bergamo; 6Department of Cellular Biotechnologies and Hematology, La Sapienza University, Roma; 7Hematology Unit, La Maddalena Hospital, Palermo; 8SC Oncoematologia, Università degli Studi di Perugia; 9Hematology University Division, Ancona; 10Department of Hematology, S. Croce e Carle Hospital, Cuneo; 11Hematology University Division, Monza; 12Hematology Unit HSR, Milano; 13Oncologia Medica, Cancer Institute FPO, IRCCS, Candiolo; 14Hematology Division, Reggio Calabria; 15Hematology Univiversity Division, Catania; 16Division of Hematology, Brescia; 17University Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano; 18Hematology Division, S. Camillo Hospital, Roma; 19SC Ematologia AO SS Antonio e Biagio e Cesare Arrigo, Alessandria; 20Hematology University Division, Modena; 21Division of Oncology, Modena; 22Division of Internal Medicine, S. Luigi Hospital, Orbassano; 23Hematology University Division, Padova; 24Hematology Unit, Cremona; 25Hematology University Division, Bari; 26Hematology Division, Pescara; 27Hematology Division, Bolzano; 28Hematology University Division, Città della Salute Hospital, Torino; 29Department of Oncology and Onco-Hematology, University of Milan, Milano; 30Nuclear Medicine Division, Città della Salute Hospital, Torino and 31Department of Health Sciences, University of Milan, Milano, Italy
Present address: §Division of Hematology, Ospedale Maggiore della Carità, Novara, ^University Hematology Division, Mauriziano Hospital, Torino °Hematology and SCT Unit, Ospedale di Ravenna
ABSTRACT
Aprospective trial conducted in the period 2000-2005 showed no survival advantage for high-dose chemotherapy with rituximab and autograft (R- HDS) versus conventional chemotherapy with rituximab (CHOP-R) as first- line therapy in 134 high-risk follicular lymphoma patients aged <60 years. The study has been updated at the 13-year median follow up. As of February 2017, 88 (66%) patients were alive, with overall survival of 66.4% at 13 years, without a significant difference between R-HDS (64.5%) and CHOP-R (68.5%). To date, 46 patients have died, mainly because of disease progression (47.8% of all deaths), secondary malignancies (3 solid tumor, 9 myelodysplasia/acute leukemia; 26.1% of all deaths), and other toxicities (21.7% of all deaths). Complete remission was documented in 98 (73.1%) patients and associated with overall survival, with 13- year estimates of 77.0% and 36.8% for complete remission versus no-complete remission, respectively. Molecular remission was documented in 39 (65%) out of 60 evaluable patients and associated with improved survival. In multivariate analysis, complete remission achievement had the strongest effect on survival (P<0.001), along with younger age (P=0.002) and female sex (P=0.013). Overall, 50 patients (37.3%) survived with no disease recurrence (18 CHOP-R, 32 R-HDS). This follow up is the longest reported on follicular lymphoma treated upfront with rituximab-chemotherapy and demonstrates an unprecedented improvement in survival compared to the pre-rituximab era, regardless of the use of intensified or conventional treatment. Complete remission was the most important factor for prolonged survival and a high proportion of patients had prolonged survival in their first remission, raising the issue of curability in follicular lymphoma. (Registered at clinicaltrials.gov identifier: 00435955)
Correspondence:
CORRADO TARELLA
corrado.tarella@unimi.it
Received: October 22, 2018. Accepted: April 10, 2019. Pre-published: April 11, 2019.
doi:10.3324/haematol.2018.209932
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/11/2241
©2019 Ferrata Storti Foundation
Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode. Copies of published material are allowed for personal or inter- nal use. Sharing published material for non-commercial pur- poses is subject to the following conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode, sect. 3. Reproducing and sharing published material for com- mercial purposes is not allowed without permission in writing from the publisher.
haematologica | 2019; 104(11)
2241
ARTICLE