Initial report of a phase II study with R-FND followed by ibritumomab tiuxetan radioimmunotherapy and rituximab maintenance in patients with untreated high-risk follicular lymphoma

Felipe Samaniego*, Peter McLaughlin, Sattva S. Neelapu, Lei Feng, Michelle Fanale, Loretta Nastoupil, Maria Alma Rodriguez, Barbara Pro, Erin Taylor, Fredrick B. Hagemeister, Nathan Fowler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

R-FND (rituximab, fludarabine, mitoxantrone, and dexamethasone) can induce molecular remissions in indolent lymphoma. The addition of 90yttrium ibritumomab tiuxetan (90YIT) radioimmunotherapy following first-line induction treatment in patients with advanced follicular lymphoma (FL) may improve remission rates. We now report 10-year follow-up results from our sequential treatment approach with an abbreviated regimen of R-FND followed by 90YIT consolidation and rituximab maintenance. Forty-nine patients were enrolled; 47 received treatment. Patients had high-risk (FLIPI score ≥3) FL of grade 1–3A and stage III/IV with adequate hematologic function. Following R-FND, the complete and partial response rates were 91% and 8.5%, respectively. After 90YIT consolidation, the CR rate increased to 97%. The 10-year PFS rate was 49%. The most common non-hematologic, grade 3 or 4 adverse events were fatigue, dyspnea, and myalgia. Five developed myelodysplastic syndrome (MDS). This treatment approach is most appropriate in FLIPI-based high-risk patients whose outlook with standard therapy is inadequate.

Original languageEnglish (US)
Pages (from-to)58-67
Number of pages10
JournalLeukemia and Lymphoma
Volume62
Issue number1
DOIs
StatePublished - 2021

Funding

For their support in bringing this project to completion, we thank the staff in the Department of Lymphoma and Myeloma at MD Anderson, including Stephanie Martch and Shayda Dioun for her assistance with writing and editing the manuscript. Our clinical protocol was approved by the MD Anderson Institutional Review Board and supported by the National Institute of Health/NCI, Cancer Center Support Grant P30 CA16672 (PI: Dr. Peter Pisters). This study was originally sponsored by Genentech and IDEC Pharmaceutical. Subsequently, IDEC’s role was taken over by Cell Therapeutics, and then Spectrum. Neither sponsor played a role in the design of the study; in the collection, analysis, and interpretation of the data; or in writing the manuscript. This study was originally sponsored by Genentech and IDEC Pharmaceutical. Subsequently, IDEC’s role was taken over by Cell Therapeutics, and then Spectrum. Neither sponsor played a role in the design of the study; in the collection, analysis, and interpretation of the data; or in writing the manuscript. Our clinical protocol was approved by the MD Anderson Institutional Review Board and supported by the National Institute of Health/NCI, Cancer Center Support Grant P30 CA16672 (PI: Dr. Peter Pisters).

Keywords

  • B-cell lymphoma
  • BCL2
  • Fludarabine
  • ibritumomab tiuxetan
  • radioimmunotherapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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