Objective: To investigate the efficacy of different regimens in previously untreated follicular lymphoma (FL) patients with bone marrow involvement.
Methods: Clinical data of 38 previously untreated FL patients with bone marrow involvement visited Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences during the period from January 2002 to December 2013 were analyzed retrospectively, in order to compare the efficacy and survival status of different regimens.
Results: The median age of onset was 43 years (19-74 years). The number of patients in low, intermediate and high risk group according to the follicular lymphoma international prognostic index (FLIPI) was 11 (28.9%), 11 (28.9%), and 16 (42.1%) respectively.And 36 of the 38 patients received combined chemotherapies. The overall response rate (ORR), complete remission (CR) rate, and partial remission (PR) rate were 100%, 66.7%, and 33.3%, respectively.A total of 31 patients (86.1%) used rituximab, in whom the 3-year overall survival (OS) was significantly higher than that in those who had not used rituximab (94.4% vs 80.0%, P=0.012), but the difference between 3-year progression-free survival (PFS) rate had no statistical significance (P=0.305). In the rituximab group, 16 patients had received RCHOP (rituximab, cyclophosphamide, epirubicin, vincristine, prednisone), 9 patients had received RFC (rituximab, fludarabine, cyclophosphamide), 6 young patients with high invasion and high tumor burden had received R-HyperCVAD (rituximab , cyclophosphamide, epirubicin, vincristine, dexamethasone). In the RFC/R-HyperCVAD group, the 3-year PFS was significantly higher than that in the RCHOP group (92.3% vs 48.9%, P=0.036), but the 3-year OS rate had no statistically significant difference (P=0.190). Compared with the RCHOP group, the 3-year PFS was significantly higher in the RFC group (100% vs 48.9%, P=0.029), but the 3-year OS rate had no statistically significant difference (100% vs 85.7%, P=0.285). Of the 36 patients who had received combined chemotherapy, 13 had received rituximab for maintenance treatment, whose 3-year PFS (92.3% vs 58.7%, P=0.025) and OS (100% vs 80.0%, P=0.040) were significantly higher than those not receiving maintenance treatment.
Conclusions: FL patients with bone marrow involvement may tend to have an onset at young age and intermediate to high FLIPI scores. These patients may benefit from rituximab combined with intensive chemotherapy. Rituximab as maintenance treatment may further improve the survival of these patients.