Long-term overall- and progression-free survival after pentostatin, cyclophosphamide and rituximab therapy for indolent non-Hodgkin lymphoma

Tamer Khashab, Fredrick Hagemeister, Jorge E. Romaguera, Michelle A. Fanale, Barbara Pro, Peter McLaughlin, M. Alma Rodriguez, Sattva S. Neelapu, Luis Fayad, Anas Younes, Lei Feng, Francisco Vega, Larry W. Kwak, Felipe Samaniego*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

In a prospective phase II trial, pentostatin combined with cyclophosphamide and rituximab (PCR) induced strong responses and was well-tolerated in previously untreated patients with advanced-stage, indolent non-Hodgkin lymphoma (iNHL). After a median patient follow-up of more than 108 months, we performed an intent-to-treat analysis of our 83 participants. Progression-free survival (PFS) rates at 108 months for follicular lymphoma (FL), marginal zone lymphoma (MZL) and small lymphocytic lymphoma (SLL) were 71%, 67% and 15%, respectively, and were affected by clinicopathological characteristics. Ten-year PFS rates for those with beta-2-microglobulin levels <2·2 and ≥2·2 mg/l prior to treatment were 71% and 21%, respectively. Patients without bone marrow involvement had 10-year PFS rates of 72% vs. 29% for those with involvement. At time of analysis, the median overall survival (OS) had not been reached. The OS rate was 64% at 10 years and differed significantly based on histology: 94% for FL, 66% for MZL and 39% for SLL. Long-term toxicities included 18 (21·7%) patients with second malignancies and 2 (2·4%) who developed myelodysplastic syndrome after receiving additional lines of chemotherapy. Our 10-year follow-up analysis confirms that PCR is an effective, robust and tolerable treatment regimen for patients with iNHL.

Original languageEnglish (US)
Pages (from-to)670-678
Number of pages9
JournalBritish Journal of Haematology
Volume185
Issue number4
DOIs
StatePublished - May 1 2019

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Pentostatin
Non-Hodgkin's Lymphoma
Cyclophosphamide
Disease-Free Survival
Survival Rate
Follicular Lymphoma
B-Cell Chronic Lymphocytic Leukemia
Lymphoma
Therapeutics
beta 2-Microglobulin
Polymerase Chain Reaction
Second Primary Neoplasms
Myelodysplastic Syndromes
Histology
Bone Marrow
Rituximab
Drug Therapy
Survival

Keywords

  • B cells
  • lymphomas
  • pentostatin
  • purine analogues
  • rituximab

ASJC Scopus subject areas

  • Hematology

Cite this

Khashab, Tamer ; Hagemeister, Fredrick ; Romaguera, Jorge E. ; Fanale, Michelle A. ; Pro, Barbara ; McLaughlin, Peter ; Rodriguez, M. Alma ; Neelapu, Sattva S. ; Fayad, Luis ; Younes, Anas ; Feng, Lei ; Vega, Francisco ; Kwak, Larry W. ; Samaniego, Felipe. / Long-term overall- and progression-free survival after pentostatin, cyclophosphamide and rituximab therapy for indolent non-Hodgkin lymphoma. In: British Journal of Haematology. 2019 ; Vol. 185, No. 4. pp. 670-678.
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abstract = "In a prospective phase II trial, pentostatin combined with cyclophosphamide and rituximab (PCR) induced strong responses and was well-tolerated in previously untreated patients with advanced-stage, indolent non-Hodgkin lymphoma (iNHL). After a median patient follow-up of more than 108 months, we performed an intent-to-treat analysis of our 83 participants. Progression-free survival (PFS) rates at 108 months for follicular lymphoma (FL), marginal zone lymphoma (MZL) and small lymphocytic lymphoma (SLL) were 71{\%}, 67{\%} and 15{\%}, respectively, and were affected by clinicopathological characteristics. Ten-year PFS rates for those with beta-2-microglobulin levels <2·2 and ≥2·2 mg/l prior to treatment were 71{\%} and 21{\%}, respectively. Patients without bone marrow involvement had 10-year PFS rates of 72{\%} vs. 29{\%} for those with involvement. At time of analysis, the median overall survival (OS) had not been reached. The OS rate was 64{\%} at 10 years and differed significantly based on histology: 94{\%} for FL, 66{\%} for MZL and 39{\%} for SLL. Long-term toxicities included 18 (21·7{\%}) patients with second malignancies and 2 (2·4{\%}) who developed myelodysplastic syndrome after receiving additional lines of chemotherapy. Our 10-year follow-up analysis confirms that PCR is an effective, robust and tolerable treatment regimen for patients with iNHL.",
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author = "Tamer Khashab and Fredrick Hagemeister and Romaguera, {Jorge E.} and Fanale, {Michelle A.} and Barbara Pro and Peter McLaughlin and Rodriguez, {M. Alma} and Neelapu, {Sattva S.} and Luis Fayad and Anas Younes and Lei Feng and Francisco Vega and Kwak, {Larry W.} and Felipe Samaniego",
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Khashab, T, Hagemeister, F, Romaguera, JE, Fanale, MA, Pro, B, McLaughlin, P, Rodriguez, MA, Neelapu, SS, Fayad, L, Younes, A, Feng, L, Vega, F, Kwak, LW & Samaniego, F 2019, 'Long-term overall- and progression-free survival after pentostatin, cyclophosphamide and rituximab therapy for indolent non-Hodgkin lymphoma', British Journal of Haematology, vol. 185, no. 4, pp. 670-678. https://doi.org/10.1111/bjh.15814

Long-term overall- and progression-free survival after pentostatin, cyclophosphamide and rituximab therapy for indolent non-Hodgkin lymphoma. / Khashab, Tamer; Hagemeister, Fredrick; Romaguera, Jorge E.; Fanale, Michelle A.; Pro, Barbara; McLaughlin, Peter; Rodriguez, M. Alma; Neelapu, Sattva S.; Fayad, Luis; Younes, Anas; Feng, Lei; Vega, Francisco; Kwak, Larry W.; Samaniego, Felipe.

In: British Journal of Haematology, Vol. 185, No. 4, 01.05.2019, p. 670-678.

Research output: Contribution to journalArticle

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T1 - Long-term overall- and progression-free survival after pentostatin, cyclophosphamide and rituximab therapy for indolent non-Hodgkin lymphoma

AU - Khashab, Tamer

AU - Hagemeister, Fredrick

AU - Romaguera, Jorge E.

AU - Fanale, Michelle A.

AU - Pro, Barbara

AU - McLaughlin, Peter

AU - Rodriguez, M. Alma

AU - Neelapu, Sattva S.

AU - Fayad, Luis

AU - Younes, Anas

AU - Feng, Lei

AU - Vega, Francisco

AU - Kwak, Larry W.

AU - Samaniego, Felipe

PY - 2019/5/1

Y1 - 2019/5/1

N2 - In a prospective phase II trial, pentostatin combined with cyclophosphamide and rituximab (PCR) induced strong responses and was well-tolerated in previously untreated patients with advanced-stage, indolent non-Hodgkin lymphoma (iNHL). After a median patient follow-up of more than 108 months, we performed an intent-to-treat analysis of our 83 participants. Progression-free survival (PFS) rates at 108 months for follicular lymphoma (FL), marginal zone lymphoma (MZL) and small lymphocytic lymphoma (SLL) were 71%, 67% and 15%, respectively, and were affected by clinicopathological characteristics. Ten-year PFS rates for those with beta-2-microglobulin levels <2·2 and ≥2·2 mg/l prior to treatment were 71% and 21%, respectively. Patients without bone marrow involvement had 10-year PFS rates of 72% vs. 29% for those with involvement. At time of analysis, the median overall survival (OS) had not been reached. The OS rate was 64% at 10 years and differed significantly based on histology: 94% for FL, 66% for MZL and 39% for SLL. Long-term toxicities included 18 (21·7%) patients with second malignancies and 2 (2·4%) who developed myelodysplastic syndrome after receiving additional lines of chemotherapy. Our 10-year follow-up analysis confirms that PCR is an effective, robust and tolerable treatment regimen for patients with iNHL.

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KW - lymphomas

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