Long-term results from a multicenter phase III study show that initial combination chemotherapy with bendamustine and rituximab more than doubled progression-free survival, to nearly six years, compared with standard R-CHOP therapy among patients with indolent and mantle cell lymphoma, according to Mathias J. Rummel, MD, PhD, Professor of Medicine at the University Hospital Giessen in Germany, lead author of the study. The bendamustine regimen was also associated with fewer side effects.
The findings are expected to change clinical practice, especially in the U.S., where the R-CHOP regimen is still widely used. (A standard chemotherapy regimen for many non-Hodgkin lymphomas, R-CHOP includes the targeted therapy rituximab plus the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone.)
The investigators compared progression-free survival between 514 patients with previously untreated indolent non-Hodgkin or mantle cell lymphomas who were randomly assigned to receive either bendamustine/rituximab (B-R) or R-CHOP. After a median follow-up of 45 months, median progression-free survival (PFS) was 69.5 months in the B-R group vs 31.2 months for the R-CHOP group. Overall survival did not differ between the two groups, partly because nearly half of the R-CHOP patients whose disease continued to progress were then permitted to receive B-R, and partly because survival for indolent lymphomas tends to be very long, making PFS the most reliable measure of clinical benefit and patient quality of life.