Assessment of Maintenance Rituximab after First-Line Bendamustine-Rituximab in Patients with Follicular Lymphoma: An Analysis from the BRIGHT Trial
Notice bibliographique
Résumé
Introduction: Maintenance rituximab (R) has been shown to improve progression-free survival (PFS) in patients with follicular lymphoma (FL) after first-line R with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) or R with cyclophosphamide, vincristine and prednisone (R-CVP) (PRIMA Trial). Whether a similar benefit is observed after first-line bendamustine-rituximab (BR) is unknown.The BRIGHT study investigated the safety and efficacy of BR versus R-CHOP or R-CVP in treatment-naive patients with indolent non-Hodgkin lymphoma or mantle cell lymphoma. Five-year follow-up data from this study has confirmed that duration of response and PFS were significantly improved in the BR treatment group. Overall survival (OS) was not statistically different between BR and R-CHOP/R-CVP. This ad hoc analysis examines the use of maintenance R in the BRIGHT study. Methods: The patient set used in this analysis consisted of 288 patients with FL who had a complete response (CR) or partial response (PR) based on the investigator9s assessment. The use of maintenance R was at the discretion of the investigator. Baseline characteristics were compared by treatment group for those patients receiving maintenance R versus those who did not receive maintenance R, as were the proportions of patients with CR and PR. Kaplan-Meier plots are presented for PFS and OS by treatment group subdivided by whether the patient received maintenance R. P values were determined by the log-rank test. Results: Among 144 patients with FL in the BR treatment group and 144 patients with FL in the R-CHOP/R-CVP treatment group, 81 (56%) and 83 (58%) received maintenance R, respectively. The baseline demographic and lymphoma characteristics of the patient groups are compared in the Table. In the BR treatment group, patients with B symptoms more commonly received maintenance R (38% vs 30%) while in the R-CHOP/R-CVP treatment group the opposite was true (29% vs 43%). In both treatment groups, patients with lactate dehydrogenase > 240 U/L and β2-microglobulin >3mg/L were less likely to receive maintenance R. In the BR treatment group, patients achieving CR to induction therapy were more likely to be assigned to no R maintenance (40% vs 22%; P= 0.0231). In the R-CHOP/R-CVP treatment group, the proportions with CR were similar in patients who did and did not receive maintenance R (19% vs 21%; P= 0.7636). Patients responding to BR (CR and PR) who received maintenance R had a significantly better PFS than responding patients who did not receive maintenance R; hazard ratio (HR) = 0.50 (95% confidence interval [CI] 0.26-0.94), P= 0.0295 (Figure). Patients responding to R-CHOP/R-CVP (CR or PR) who received maintenance R had a trend towards better PFS than responding patients who did not receive maintenance R; HR = 0.66 [95% CI 0.38-1.16], P= 0.1443. OS tended to be better in patients assigned to maintenance R (BR treatment group, HR = 0.39 [95% CI 0.14-1.05], P= 0.0537; R-CHOP/R-CVP group, HR = 0.32 (0.10-1.05; P= 0.0481). Conclusions: In this retrospective analysis of FL patients treated with BR induction therapy on the BRIGHT study, maintenance R significantly improved PFS with a trend towards improvement in OS, despite the fact that patients with CR were less likely to receive maintenance R. Maintenance R also showed a tendency towards improved outcomes after R-CHOP/R-CVP, consistent with data from randomized clinical trials (RCTs). Given that the application of maintenance R was based on investigator discretion, it is possible that the observed effect was due to confounding variables. However, the overall improvement in PFS in the maintenance R patients appears to be at least as great following BR as following R-CHOP/R-CVP and supports the notion of testing maintenance R after BR therapy in RCTs. Disclosures Kahl: Celgene: Consultancy; Gilead: Consultancy; ADC Therapeutics: Research Funding; Seattle Genetics: Consultancy; Genentech: Consultancy. Burke: Bayer: Consultancy; Celgene: Consultancy; Incyte: Consultancy; Gilead: Consultancy; Genentech: Consultancy. van der Jagt: Lundbeck, Teva: Consultancy; Teva: Research Funding. Wood: Bayer: Consultancy; Bayer, Boehringer Ingelheim, Bristol Myer Squibb: Honoraria. MacDonald: Lundbeck Canada, Roche Canada: Honoraria. Trotman: Janssen Cilag: Other: Funding facilitating research paid to third party (BioGrid Australia), Research Funding. Simpson: Amgen: Research Funding; Onyx: Research Funding; Pharmacyclics LLC, an AbbVie Company: Research Funding; Roche: Honoraria; Celgene: Honoraria, Other: travel expenses. Kolibaba: Celgene: Research Funding; Cell Therapeutics: Research Funding; Genentech: Research Funding; Gilead Sciences, Inc: Consultancy, Research Funding; Janssen: Research Funding; Novartis: Research Funding; Pharmacyclics: Research Funding; Seattle Genetics: Research Funding; TG Therapeutics: Honoraria, Research Funding; Acerta: Research Funding. Hallman: Teva Pharmaceuticals: Employment. Chen: Teva Pharmaceuticals: Employment. Flinn: Acerta: Research Funding; Novartis: Research Funding; Celgene: Research Funding; Pharmacyclics LLC: Research Funding; Trillium: Research Funding; Gilead: Research Funding; Pharmacyclics: Research Funding; Verastem: Research Funding; AbbVie Company: Research Funding; Merck: Research Funding; Janssen: Research Funding; Curis: Research Funding; Incyte: Research Funding; KITE: Research Funding; Constellation: Research Funding; Infinity: Research Funding; Agios: Research Funding; Beigene: Research Funding; Forty Seven: Research Funding; Genentech: Research Funding; Takeda: Research Funding; TG Therapeutics: Research Funding; Calithera: Research Funding; Janssen: Research Funding; Seattle Genetics: Research Funding; Portola: Research Funding; Pfizer: Research Funding.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,003 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».