Background

Rituximab (R) has shown impressive response and prolonged progression free survival (PFS) in patients with indolent lymphoma when combined with CHOP. Randomized phase III trials adding rituximab to a variety of different regimen confirmed this benefit in both previously treated and untreated patients with advanced indolent lymphoma. Furthermore these trials indicating a trend towards improved overall survival (OS) for a combined immunochemotherapy with R. Here we report updated results of a comprehensive systematic review in this group of patients comparing R and chemotherapy with chemotherapy alone with respect to OS, disease control, overall response (OR) and toxicity.

Methods

Only randomized controlled trials (RCT) comparing R-chemo with chemotherapy alone in patients with newly diagnosed or relapsed indolent lymphoma and mantle cell lymphoma (MCL) were included. Medical databases (Cochrane Library, MEDLINE, EMBASE) and conference proceedings were searched (1990–2005). We included full-text and abstract publications. Number needed to treat (NNT) were calculated to facilitate interpretation.

Results

We included seven eligible RCTs involving a total of 1943 patients with follicular lymphoma (FL), MCL and other indolent lymphoma. Studies were published as full text (5), and in abstract form (2). OS was statistically significant improved in the R-chemo group when compared to chemotherapy alone (HR; hazard ratio: 0,65; 95% CI 0,54 – 0,78). OR (RR; relative risk: 1.21; 95% CI 1.16–1.27) and disease control (HR: 0.62; 95% CI 0.55–0.71) were also significantly superior after R-chemo. The RR for developing fever and leukocytopenia was significantly higher with R-chemo, but not associated with an increased risk of infection.

Conclusion

The systematic review demonstrated improved OS, OR and disease control for patients with indolent lymphoma and in the subgroups of follicular and mantle cell lymphoma when treated with R-chemo compared to chemotherapy alone.

Topics:
mantle-cell lymphoma, rituximab, chemotherapy regimen, non-hodgkin's lymphoma, indolent, cyclophosphamide, doxorubicin, prednisone, and vincristine, fever, follicular lymphoma, leukopenia, toxic effect, infection risk

Disclosure: No relevant conflicts of interest to declare.

Author notes

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Corresponding author

2006, The American Society of Hematology
2006
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