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Blood, 15 February 2005, Vol. 105, No. 4, pp. 1417-1423.
Prepublished online as a Blood First Edition Paper on October 19, 2004; DOI 10.1182/blood-2004-08-3175.
Previous Article | Table of Contents | Next Article 
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma
Robert Marcus,
Kevin Imrie,
Andrew Belch,
David Cunningham,
Eduardo Flores,
John Catalano,
Philippe Solal-Celigny,
Fritz Offner,
Jan Walewski,
Joäo Raposo,
Andrew Jack, and
Paul Smith
From Addenbrooke's Hospital, Cambridge, United Kingdom; Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; Royal Marsden Hospital, Surrey, United Kingdom; Hospital Gregorio Marañón, Madrid, Spain; Monash Medical Centre, Clayton, Australia; Clinique Victor Hugo, Le Mans, France; Dienst Hematologie, UZ Gent, Belgium; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hospital Santa Maria, Lisboa, Portugal; Leeds General Infirmary, Leeds, United Kingdom; and Cancer Research UK and University College London (UCL) Cancer Trials Centre, London, United Kingdom.
The combination of cyclophosphamide, vincristine, and prednisone (CVP) is one of several standard treatment options for advanced follicular lymphoma. This, like similar chemotherapeutic regimens, induces response rates of 60% to 80%, with a median response duration of under 2 years. Rituximab, a chimeric monoclonal antibody against CD20, is active in follicular lymphoma, both as monotherapy and in combination with chemotherapy. Previously untreated patients with stages III to IV follicular lymphoma were randomly assigned to receive either 8 cycles of CVP plus rituximab (R-CVP; n = 162) or CVP (n = 159). Overall and complete response rates were 81% and 41% in the R-CVP arm versus 57% and 10% in the CVP arm, respectively (P < .0001). At a median follow-up of 30 months, patients treated with R-CVP had a very significantly prolonged time to progression (median 32 months versus 15 months for CVP; P < .0001). Median time to treatment failure was 27 months in patients receiving R-CVP and 7 months in the CVP arm (P < .0001). Rituximab did not add significantly to the toxicity of CVP. The addition of rituximab to the CVP regimen significantly improves the clinical outcome in patients with previously untreated advanced follicular lymphoma, without increased toxicity.

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C. Nabhan
It Is Follicular... . So, Why CHOP?
J. Clin. Oncol.,
March 1, 2007;
25(7):
915 - 916.
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A. Koster, H. A. Tromp, J. M.M. Raemaekers, G. F. Borm, K. Hebeda, M. A. MacKenzie, and J. H.J.M. van Krieken
The prognostic significance of the intra-follicular tumor cell proliferative rate in follicular lymphoma
Haematologica,
February 1, 2007;
92(2):
184 - 190.
[Abstract]
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C Nickenig, M Dreyling, E Hoster, W-D Ludwig, B Dorken, M Freund, C Huber, A Ganser, L Trumper, R Forstpointner, et al.
Initial chemotherapy with mitoxantrone, chlorambucil, prednisone impairs the collection of stem cells in patients with indolent lymphomas--results of a randomized comparison by the German Low-Grade Lymphoma Study Group
Ann. Onc.,
January 1, 2007;
18(1):
136 - 142.
[Abstract]
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G. A. Salles
Clinical Features, Prognosis and Treatment of Follicular Lymphoma
Hematology,
January 1, 2007;
2007(1):
216 - 225.
[Abstract]
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C. Bello and E. M. Sotomayor
Monoclonal Antibodies for B-Cell Lymphomas: Rituximab and Beyond
Hematology,
January 1, 2007;
2007(1):
233 - 242.
[Abstract]
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R. Forstpointner, M. Unterhalt, M. Dreyling, H.-P. Bock, R. Repp, H. Wandt, C. Pott, J. F. Seymour, B. Metzner, A. Hanel, et al.
Maintenance therapy with rituximab leads to a significant prolongation of response duration after salvage therapy with a combination of rituximab, fludarabine, cyclophosphamide, and mitoxantrone (R-FCM) in patients with recurring and refractory follicular and mantle cell lymphomas: results of a prospective randomized study of the German Low Grade Lymphoma Study Group (GLSG)
Blood,
December 15, 2006;
108(13):
4003 - 4008.
[Abstract]
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K. D. Khan, C. Emmanouilides, D. M. Benson Jr., D. Hurst, P. Garcia, G. Michelson, S. Milan, A. K. Ferketich, L. Piro, J. P. Leonard, et al.
A Phase 2 Study of Rituximab in Combination with Recombinant Interleukin-2 for Rituximab-Refractory Indolent Non-Hodgkin's Lymphoma
Clin. Cancer Res.,
December 1, 2006;
12(23):
7046 - 7053.
[Abstract]
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R. E. Marcus, P. Solal-Celigny, K. Imrie, J. V. Catalano, A. Dmoszynska, J. C. Raposo, F. C. Offner, and J. Gomez-Codina
MabThera (Rituximab) Plus Cyclophosphamide, Vincristine and Prednisone (CVP) Chemotherapy Improves Survival in Previously Untreated Patients with Advanced Follicular Non-Hodgkin's Lymphoma (NHL).
Blood (ASH Annual Meeting Abstracts),
November 16, 2006;
108(11):
481 - 481.
[Abstract]
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M. H. J. van Oers, R. Klasa, R. E. Marcus, M. Wolf, E. Kimby, R. D. Gascoyne, A. Jack, M. van't Veer, A. Vranovsky, H. Holte, et al.
Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial
Blood,
November 15, 2006;
108(10):
3295 - 3301.
[Abstract]
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C. Sebban, N. Mounier, N. Brousse, C. Belanger, P. Brice, C. Haioun, H. Tilly, P. Feugier, R. Bouabdallah, C. Doyen, et al.
Standard chemotherapy with interferon compared with CHOP followed by high-dose therapy with autologous stem cell transplantation in untreated patients with advanced follicular lymphoma: the GELF-94 randomized study from the Groupe d'Etude des Lymphomes de l'Adulte (GELA)
Blood,
October 15, 2006;
108(8):
2540 - 2544.
[Abstract]
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M. F. Leahy, J. F. Seymour, R. J. Hicks, and J. H. Turner
Multicenter Phase II Clinical Study of Iodine-131-Rituximab Radioimmunotherapy in Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma
J. Clin. Oncol.,
September 20, 2006;
24(27):
4418 - 4425.
[Abstract]
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O. W. Press, J. M. Unger, R. M. Braziel, D. G. Maloney, T. P. Miller, M. LeBlanc, and R. I. Fisher
Phase II Trial of CHOP Chemotherapy Followed by Tositumomab/Iodine I-131 Tositumomab for Previously Untreated Follicular Non-Hodgkin's Lymphoma: Five-Year Follow-Up of Southwest Oncology Group Protocol S9911
J. Clin. Oncol.,
September 1, 2006;
24(25):
4143 - 4149.
[Abstract]
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D. Decaudin, P. de Cremoux, A. Vincent-Salomon, R. Dendale, and L. L.-L. Rouic
Ocular adnexal lymphoma: a review of clinicopathologic features and treatment options
Blood,
September 1, 2006;
108(5):
1451 - 1460.
[Abstract]
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C. Buske, E. Hoster, M. Dreyling, J. Hasford, M. Unterhalt, W. Hiddemann, and for the German Low Grade Lymphoma Study Group (GLS
The Follicular Lymphoma International Prognostic Index (FLIPI) separates high-risk from intermediate- or low-risk patients with advanced-stage follicular lymphoma treated front-line with rituximab and the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with respect to treatment outcome
Blood,
September 1, 2006;
108(5):
1504 - 1508.
[Abstract]
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M. Provencio, S. Cerdeira, F. Bonilla, A. Sanchez, and P. Espana
Rapid-infusion rituximab in lymphoma treatment
Ann. Onc.,
June 1, 2006;
17(6):
1027 - 1028.
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Q. Liu, L. Fayad, F. Cabanillas, F. B. Hagemeister, G. D. Ayers, M. Hess, J. Romaguera, M. A. Rodriguez, A. M. Tsimberidou, S. Verstovsek, et al.
Improvement of Overall and Failure-Free Survival in Stage IV Follicular Lymphoma: 25 Years of Treatment Experience at The University of Texas M.D. Anderson Cancer Center
J. Clin. Oncol.,
April 1, 2006;
24(10):
1582 - 1589.
[Abstract]
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A. Hagenbeek, H. Eghbali, S. Monfardini, U. Vitolo, P. J. Hoskin, C. de Wolf-Peeters, K. MacLennan, E. Staab-Renner, J. Kalmus, A. Schott, et al.
Phase III Intergroup Study of Fludarabine Phosphate Compared With Cyclophosphamide, Vincristine, and Prednisone Chemotherapy in Newly Diagnosed Patients With Stage III and IV Low-Grade Malignant Non-Hodgkin's Lymphoma
J. Clin. Oncol.,
April 1, 2006;
24(10):
1590 - 1596.
[Abstract]
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L. H. Sehn
Optimal Use of Prognostic Factors in Non-Hodgkin Lymphoma
Hematology,
January 1, 2006;
2006(1):
295 - 302.
[Abstract]
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M. S. Czuczman
Controversies in Follicular Lymphoma: "Who, What, When, Where, and Why?" (Not Necessarily in That Order!)
Hematology,
January 1, 2006;
2006(1):
303 - 310.
[Abstract]
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W. H. Wilson
R-CHOP strikes again with survival benefit in follicular lymphoma
Blood,
December 1, 2005;
106(12):
3678 - 3679.
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W. Hiddemann, M. Kneba, M. Dreyling, N. Schmitz, E. Lengfelder, R. Schmits, M. Reiser, B. Metzner, H. Harder, S. Hegewisch-Becker, et al.
Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group
Blood,
December 1, 2005;
106(12):
3725 - 3732.
[Abstract]
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R. I. Fisher, M. LeBlanc, O. W. Press, D. G. Maloney, J. M. Unger, and T. P. Miller
New Treatment Options Have Changed the Survival of Patients With Follicular Lymphoma
J. Clin. Oncol.,
November 20, 2005;
23(33):
8447 - 8452.
[Abstract]
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P. Solal-Celigny, K. Imrie, A. Belch, K. S. Robinson, D. Cunningham, A. Rueda, J. Catalano, F. Offner, J. Walewski, J. Raposo, et al.
Mabthera (Rituximab) Plus CVP Chemotherapy for First-Line Treatment of Stage III/IV Follicular Non-Hodgkin's Lymphoma (NHL): Confirmed Efficacy with Longer Follow-Up.
Blood (ASH Annual Meeting Abstracts),
November 16, 2005;
106(11):
350 - 350.
[Abstract]
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W. Hiddemann, C. Buske, M. Dreyling, O. Weigert, G. Lenz, R. Forstpointner, C. Nickenig, and M. Unterhalt
Treatment Strategies in Follicular Lymphomas: Current Status and Future Perspectives
J. Clin. Oncol.,
September 10, 2005;
23(26):
6394 - 6399.
[Abstract]
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D. G. Maloney
Immunotherapy for Non-Hodgkin's Lymphoma: Monoclonal Antibodies and Vaccines
J. Clin. Oncol.,
September 10, 2005;
23(26):
6421 - 6428.
[Abstract]
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G. Lenz, M. Dreyling, M. Unterhalt, and W. Hiddemann
In Reply:
J. Clin. Oncol.,
September 1, 2005;
23(25):
6264 - 6266.
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C. Nabhan
Should We Transplant Indolent Lymphoma?
J. Clin. Oncol.,
September 1, 2005;
23(25):
6263 - 6264.
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T. Kober, N. Skoetz, S. Trelle, J. Bohlius, and A. Engert
Third Biannual Report of the Cochrane Haematological Malignancies Group
J Natl Cancer Inst,
August 17, 2005;
97(16):
E2 - E.
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S. M. Ansell and J. Armitage
Non-Hodgkin Lymphoma: Diagnosis and Treatment
Mayo Clin. Proc.,
August 1, 2005;
80(8):
1087 - 1097.
[Abstract]
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P. Feugier, A. Van Hoof, C. Sebban, P. Solal-Celigny, R. Bouabdallah, C. Ferme, B. Christian, E. Lepage, H. Tilly, F. Morschhauser, et al.
Long-Term Results of the R-CHOP Study in the Treatment of Elderly Patients With Diffuse Large B-Cell Lymphoma: A Study by the Groupe d'Etude des Lymphomes de l'Adulte
J. Clin. Oncol.,
June 20, 2005;
23(18):
4117 - 4126.
[Abstract]
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M. Ghielmini
Multimodality Therapies and Optimal Schedule of Antibodies: Rituximab in Lymphoma as an Example
Hematology,
January 1, 2005;
2005(1):
321 - 328.
[Abstract]
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