Rituximab Plus Bendamustine: Superior to R-CHOP for Grade 3A Follicular Lymphoma

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The median PFS was significantly longer in the R-B arm: 15.0 years compared with 11.7 years in the R-CHOP arm.
The median PFS was significantly longer in the R-B arm: 15.0 years compared with 11.7 years in the R-CHOP arm.

Rituximab plus bendamustine (R-B) is a well-tolerated first-line therapy compared with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP), and leads to improved progression-free survival (PFS) among patients with grade 3A follicular lymphoma (FL3A), according to a study published in The Oncologist.1

Previous studies demonstrated that R-B is superior to R-CHOP and rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) — 2 first-line options for FL — but its efficacy specifically for FL3A was previously unestablished.

For this retrospective study, researchers assessed the outcomes of 132 patients with FL3A who were treated in the first-line with R-B or R-CHOP for up to 6 cycles. A greater portion of patients in the R-B arm were characterized with worse prognostic factors such as bone marrow involvement and Ki67 expression greater than 30% compared with patients in the R-CHOP arm (59% vs 11%, respectively; P < .001; 45% vs 19%, respectively; P < .001), but there were no significant differences in BCL2 expression with or without BCL6 co-expression between the arms. Follow-up visits were conducted 1 month after therapy completion and then every 3 to 6 months for 5 years to evaluate response.

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The average follow-up was 15.2 years vs 14.8 years for the R-B vs the R-CHOP arm, respectively. The median PFS was significantly longer in the R-B arm: 15.0 years compared with 11.7 years in the R-CHOP arm (P = .03). Median OS did not differ significantly and was not reached in either treatment arm.

R-B had a superior safety profile compared with R-CHOP, with improvements in the rates of grade 1 to 2 and 3 to 4 neutropenia (6% vs 30%, respectively; P < .001; 10% vs 26%, respectively; P < .01) — which led to higher rates of infection in the R-CHOP arm (35% vs 5%, respectively; P < .006) — as well as improved rates of anemia, thrombocytopenia, alopecia, peripheral neuropathy, and drug-associated erythematous skin reactions.

Dose reductions also occurred less frequently in the R-B arm compared with the R-CHOP arm (1% vs 12%, respectively; P =.004).


  1. Mondello P, Steiner N, Willenbacher W, et al. Bendamustine plus rituximab versus R-CHOP as first-line treatment for patients with follicular lymphoma grade 3A: evidence from a multicenter, retrospective study. Oncologist. 2017 Jan 9. doi: 10.1634/theoncologist.2017-0037 [Epub online ahead of print] 

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