(ChemotherapyAdvisor) –  Patients who receive rituximab plus chemotherapy or systemic therapy and rituximab plus radiotherapy for stage I follicular lymphoma have significantly better progression-free survival (PFS) rates than patients receiving radiotherapy alone (XRT), according to a new study in the Journal of Clinical Oncology.

“In this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be the standard for this presentation,” reported lead author Jonathan W. Friedberg, MD, University of Rochester, Rochester, NY,  and coauthors.

Of 471 study participants, 206 had received “rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study” involving a whole-body CT scan, positron-emission tomography (PET)/CT scan, or both.

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At a median follow-up of 57 months, after adjusting for histology, LDH and presence of B symptoms, rigorously-staged patients receiving rituximab and systematic chemotherapy plus radiotherapy, or rituximab plus chemotherapy, had significantly longer PFS than patients receiving XRT (Hazard Ratio [HR] = 0.11, 95% confidence intervals (CI), 0.01 – 0.83; HR = 0.36, CI, 0.16 – 0.82). No differences in overall survival (OS) were identified.

The findings “challenge the widespread notion that the standard treatment for patients with localized FL is IF-RT (involved-field radiotherapy),” commented Silvia Montoto, MD, Centre for Haemato-oncology, Queen Mary University of London, UK. Both the American National Comprehensive Cancer Network and European Society for Medical Oncology guidelines list IF-RT as the preferred treatment for stage I and II follicular lymphoma, Dr. Montoto noted.

Rigorous staging was also associated with longer PFS, but not OS. After adjusting for age, treatment and academic versus community practice settings, PFS among rigorously-staged patients was superior (HR = 0.63, 95% CI, 0.44 – 0.92).  

Rituximab is a chimeric monoclonal antibody that targets B-cell CD20 protein.

The study was partly funded by Genentech, which markets rituximab.