A comparative analysis of prognostic factor models for follicular lymphoma based on a phase III trial of CHOP-rituximab versus CHOP + 131iodine- tositumomab

Oliver W. Press, Joseph M. Unger, Lisa M Rimsza, Jonathan W. Friedberg, Michael Leblanc, Myron S. Czuczman, Mark Kaminski, Rita M. Braziel, Catherine S Perry, Ajay K. Gopal, David G. Maloney, Bruce D. Cheson, Shaker R. Dakhil, Thomas P Miller, Richard I. Fisher

Research output: Contribution to journalArticle

23 Scopus citations


Purpose: There is currently no consensus on optimal frontline therapy for patients with follicular lymphoma. We analyzed a phase III randomized intergroup trial comparing six cycles of CHOP-R (cyclophosphamide-Adriamycin-vincristine- prednisone (Oncovin)-rituximab) with six cycles of CHOP followed by iodine-131 tositumomab radioimmunotherapy (RIT) to assess whether any subsets benefited more from one treatment or the other, and to compare three prognostic models. Experimental Design:Weconducted univariate and multivariate Cox regression analysesof532 patients enrolled on this trial and compared the prognostic value of the FLIPI (follicular lymphoma international prognostic index), FLIPI2, and LDH + β2M (lactate dehydrogenase + β2-microglobulin) models. Results: Outcomes were excellent, but not statistically different between the two study arms [5-year progression-free survival (PFS) of 60% with CHOP-R and 66% with CHOP-RIT (P = 0.11); 5-year overall survival (OS) of 92% with CHOP-R and 86% with CHOP-RIT (P = 0.08); overall response rate of 84% for both arms]. The only factor found to potentially predict the impact of treatment was serum β2M; among patients with normal β2M, CHOP-RIT patients had better PFS compared with CHOP-R patients, whereas among patients with high serum β2M, PFS by arm was similar (interaction P value = 0.02). Conclusions: All three prognostic models (FLIPI, FLIPI2, and LDH + β2M) predicted both PFS and OS well, though the LDH + β2M model is easiest to apply and identified an especially poor risk subset. In an exploratory analysis using the latter model, there was a statistically significant trend suggesting that low-risk patients had superior observed PFS if treated with CHOP-RIT, whereas high-risk patients had a better PFS with CHOP-R.

Original languageEnglish (US)
Pages (from-to)6624-6632
Number of pages9
JournalClinical Cancer Research
Issue number23
Publication statusPublished - Dec 1 2013


ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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