A Comparative Analysis of Prognostic Factor Models for Follicular Lymphoma Based on a Phase III Trial of CHOP-Rituximab versus CHOP+(131)Iodine-Tositumomab

作者：Press Oliver W^*; Unger Joseph M; Rimsza Lisa M; Friedberg Jonathan W; LeBlanc Michael; Czuczman Myron S; Kaminski Mark; Braziel Rita M; Spier Catherine; Gopal Ajay K; Maloney David G; Cheson Bruce D; Dakhil Shaker R; Miller Thomas P; Fisher Richard I

来源：Clinical Cancer Research, 2013, 19(23): 6624-6632.

DOI：10.1158/1078-0432.CCR-13-1120

There is currently no consensus on optimal frontline therapy for patients with follicular lymphoma. We analyzed a phase III randomized intergroup trial comparing six cycles of CHOP-R (cyclophosphamide-Adriamycin-vincristine-prednisone (Oncovin)-rituximab) with six cycles of CHOP followed by iodine-131 tositumomab radioimmunotherapy (RIT) to assess whether any subsets benefited more from one treatment or the other, and to compare three prognostic models. %26lt;br%26gt;Experimental Design: Weconducted univariate and multivariate Cox regression analyses of 532 patients enrolled on this trial and compared the prognostic value of the FLIPI (follicular lymphoma international prognostic index), FLIPI2, and LDH + beta 2M (lactate dehydrogenase + beta 2-microglobulin) models. %26lt;br%26gt;Results: Outcomes were excellent, but not statistically different between the two study arms [5-year progression-free survival (PFS) of 60% with CHOP-R and 66% with CHOP-RIT (P 0.11); 5-year overall survival (OS) of 92% with CHOP-R and 86% with CHOP-RIT (P 0.08); overall response rate of 84% for both arms]. The only factor found to potentially predict the impact of treatment was serum beta 2M; among patients with normal beta 2M, CHOP-RIT patients had better PFS compared with CHOP-R patients, whereas among patients with high serum beta 2M, PFS by arm was similar (interaction P value 0.02). %26lt;br%26gt;Conclusions: All three prognostic models (FLIPI, FLIPI2, and LDH + beta 2M) predicted both PFS and OS well, though the LDH + beta 2M model is easiest to apply and identified an especially poor risk subset. In an exploratory analysis using the latter model, there was a statistically significant trend suggesting that low-risk patients had superior observed PFS if treated with CHOP-RIT, whereas high-risk patients had a better PFS with CHOP-R. Clin Cancer Res; 19(23); 6624-32.

• 出版日期2013-12-1