Introduction

Follicular lymphoma (FL) is the most frequent type of indolent lymphoma in western countries, but the incidence is lower in Asia. Several clinical trials have demonstrated the advantage of progression-free survival for rituximab maintenance (R-maintenance) in FL in western countries. Nevertheless, the clinical benefits of R-maintenance in Asian FL patients are still uncertain. In this study, we aimed to demonstrate this clinical benefits in Taiwan FL patients by utilizing our nation-wide database, i.e. Taiwan Cancer Registry Database (TCRD) and National Health Insurance Research Database (NHIRD).

Methods

From 2009 to 2012, 836 patients with newly diagnosed FL were identified in TCRD. Their cancer-specific information was obtained from TCRD, the claim-based information (including demographic, medical resource utilization and treatment pattern) was retrieved from NHIRD, and survival information was ascertained by the National Death Registry Database.

The study population was further restricted to those patients with stage II-IV disease and receiving 4-8 cycles of rituximab-containing multi-agent chemotherapy as induction, and the patients who died or received chemotherapies again within 180 days after the end date of the induction were excluded for suspected refractory cases to frontline treatments. Total 396 patients were included. Their demographics, clinical parameters and outcome (overall survival (OS) and time to next treatment (TTNT)) were subjected for analysis.

Results

Among the 396 targeted patients, 260 underwent R-maintenance, and 136 did not receive any R-maintenance or other therapies (identified as the observation group) after rituximab containing induction therapies. Compared with the observation group, those patients receiving R-maintenance had similar distribution in age, gender, Ann Arbor stage, Charlson Comorbidity Index and practice setting. However, those with R-maintenance underwent less intensive induction chemotherapies (less R-CHOP receiving rate; 53.5% in R-maintenance, versus 66.2% in observation; p value 0.0150) and less cycles of rituximab-containing induction therapies (the rate of receiving 7-8 cycles induction therapies, 25.8% in R-maintenance, versus 41.9% in observation; p value 0.0010).

The patients receiving R-maintenance had a significantly better OS in univariate analysis (hazard ratio (HR), 0.43; 95% confidence interval (CI), 0.20-0.91; Figure a) and even in multivariate analysis (HR, 0.42; 95% CI, 0.19-0.91) after potential confounding are adjusted. In multi-variate analysis, elder age (more than 60 years) and stage IV disease also showed negative impacts on OS. On the other hand, the TTNT was similar in the R-maintenance and observation groups (multivariate analysis, HR, 0.96; 95% CI, 0.65-1.42; Figure b), and other factors neither did not alter TTNT significantly.

Conclusion

Our study is the first real-world study which demonstrates the overall survival benefit of R-maintenance in newly diagnosed FL patients after induction therapy in Asian population.

Figure
Figure.
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Disclosures

Tien: Celgene International Sàrl: Research Funding. Ko: Celgene International Sàrl: Research Funding.

Topics:
follicular lymphoma, rituximab, taiwan, neoadjuvant therapy, chemotherapy regimen, cancer, non-hodgkin's lymphoma, indolent, r-chop, asia, univariate analysis

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2017 by The American Society of Hematology
2017
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