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Lymphoma

The addition of rituximab to front-line therapy with CHOP (R-CHOP) results in a higher response rate and longer time to treatment failure in patients with lymphoplasmacytic lymphoma: results of a randomized trial of the German Low-Grade Lymphoma Study Group (GLSG)

Leukemia volume 23, pages 153–161 (2009)Cite this article

Abstract

Lymphoplasmacytic lymphoma (LPL) is an indolent lymphoma with moderate sensitivity to conventional chemotherapy. This study investigated whether the addition of rituximab to standard chemotherapy improves treatment outcome in LPL and the subgroup of LPL patients fulfilling the criteria of Waldenstroem's macroglobulinemia (WM). A total of 69 patients with previously untreated LPL were enrolled into the trial; 64 patients were evaluable for treatment outcome. In all, 48 of the 64 LPL patients fulfilled the criteria of WM. Patients were randomly assigned to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone, n=34) or CHOP (n=30). R-CHOP resulted in significantly higher overall response (OR) rate (94 vs 67%, P=0.0085) in the LPL patients and in the WM subgroup (91 vs 60%, P=0.0188). With a median observation time of 42 months, R-CHOP induced a significantly longer time to treatment failure (TTF) with a median of 63 months for R-CHOP vs 22 months in the CHOP arm in the LPL patients (P=0.0033) and in the WM subgroup (P=0.0241). There was no major difference of treatment-associated toxicity between both treatment groups. These data indicate that the addition of rituximab to front-line chemotherapy improves treatment outcome in patients with LPL or WM.

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Acknowledgements

This study was supported by the Deutsche Krebshilfe (T14/96/Hi 1) and the Deutsches Bundesministerium für Bildung und Familie as part of the Competence Network Malignant Lymphomas. The following participating persons and institutions recruited patients into the study.

Gensicke, Dravoj, Stadtkrankenhaus Arolsen; Langer, Meusner, Ubbo-Emmius-Klinik, Aurich; Ludwig, Matylis, Robert-Rössle-Klinic, Charité, Campus Buch; Weh, Angrick, Franziskus Hospital, Bielefeld; Schmiegel, Graeven, Universitätsklinik Bochum; Musch, Röhl, Mann, Marien-Hospital Bottrop; Wörmann, Jordan, Pies, Städtisches Klinkum Braunschweig; Obst, Praxis, Burgwedel; Lohmann, Krankenhaus Coesfeld; von Grünhagen, Praxis, Cottbus; Kleinsorge, Praxis, Detmold; Becker, Meier, Hans Susemil Krankenhaus, Emden; Fuchs, Wehle-Ilka, St-Antonius-Hospital, Eschweiler; Eckert, Graeter, Städt. Kliniken, Esslingen; Massner, Praxis, Frankenthal; Mertelsmann, Finke, Universitätsklinik Freiburg i. Br.; Schliesser, Praxis, Giessen; Trümper, Glaß, Binder, Universitätsklinik Göttingen; Eimermacher, Lindemann, Kath. Krankenhaus, Hagen; Hurtz, Rohrberg, Schmidt, Praxis, Halle/Saale; Bracht, Behn, St Sixtus-Hospital, Haltern Am See; Zander, Kröger, Renges, Universitätsklinik Hamburg; Müller, Klinikum Nord, Hamburg; Henne, Praxis, Hechingen; Freier, Praxis, Hildesheim; Pfreundschuh, Universitätsklinik Homburg/Saar; Höffken, Fricke, Wedding, Universitätsklinik Jena; Kneba, Universitätsklinik Kiel; Hallek, Reiser, Universitätsklinik Köln; Schmitz, Steinmetz, Praxis, Köln; Müller, Praxis, Leer; Aldaoud, Schwarzer, Praxis, Leipzig; Halm, Park-Krankenhaus, Leipzig; Wagner, Peters, Universitätsklinik Lübeck; Huber, Fischer, Heß, Universitätsklinik Mainz; Graeven, Kohl, Verbeek, Kliniken Maria Hilf, Mönchengladbach; Berdel, Universitätsklinik Münster; Hutzschenreuter, Praxis, Nordhorn; Wilhelm, Wandt, Lechner, Klinikum Nürnberg, Nürnberg; Böck, Ballo, Praxis, Offenbach; Henning-Köhne, Metzner, Klinikum Oldenburg, Oldenburg; Andreesen, Krause, Mayer, Universitätsklinik Regensburg; Kreuser, Krankenhaus Barmherzige Brüder, Regensburg; Daus, Jacobs, Schmits, Praxis, Saarbrücken; Walter, Schmid, Marienhospital, Stuttgart; Mergenthaler, Schleicher, Katharinenhospital, Stuttgart; Heidemann, Kaesberger, Diakonieklinikum Stuttgart; Clemens, Mutterhaus der Borromäerinnen, Trier; Diers, Twiessel, Marienhospital, Vechta; Sandmann, Becker, Kliniken St Antonius, Wuppertal; Einsele, Weissinger, Reimer, Universitätsklinik Würzburg.

Author information

Authors and Affiliations

  1. Department of Internal Medicine III, University of Munich, Campus Großhadern, Munich, Germany

    C Buske, E Hoster, M Dreyling, M Unterhalt & W Hiddemann

  2. Department of Medical Informatics, Biometry and Epidemiology (IBE), University of Munich, Munich, Germany

    E Hoster

  3. Department of Medicine II, Catholic Hospital Hagen, Hagen, Germany

    H Eimermacher

  4. Department of Medicine 5, Hospital Nuernberg North, Nuernberg, Germany

    H Wandt

  5. Department of Medicine II, Klinikum Oldenburg, Oldenburg, Germany

    B Metzner

  6. Department of Hematology/Oncology, St Antonius Hospital, Eschweiler, Germany

    R Fuchs

  7. Department of Medicine I, University Medical School Saarland, Homburg, Germany

    J Bittenbring

  8. Department of Medicine, City Hospital Braunschweig, Braunschweig, Germany

    B Woermann

  9. Department of Hematology/Oncology, Georg-August-University, Goettingen, Germany

    K Hohloch

  10. Department of Internal Medicine III, Johannes-Gutenberg-University, Mainz, Germany

    G Hess

  11. Robert-Rössle-Clinic at the HELIOS Clinic Berlin-Buch, Charité, Campus Buch, Berlin, Germany

    W-D Ludwig

  12. Practice for Hematology/Oncology, Saarbruecken, Germany

    J Schimke

  13. Practice of Hematology/Oncology, Koeln, Germany

    S Schmitz

  14. Department of Internal Medicine II, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

    M Kneba

  15. Department of Internal Medicine I, University of Cologne, Cologne, Germany

    M Reiser

  16. Department of Hematology and Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany

    U Graeven

  17. Department of Haematopathology and Lymph Node Registry Kiel, Schleswig-Holstein University Hospitals, Campus Kiel, Kiel, Germany

    W Klapper

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  1. C Buske
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Correspondence to C Buske.

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Buske, C., Hoster, E., Dreyling, M. et al. The addition of rituximab to front-line therapy with CHOP (R-CHOP) results in a higher response rate and longer time to treatment failure in patients with lymphoplasmacytic lymphoma: results of a randomized trial of the German Low-Grade Lymphoma Study Group (GLSG). Leukemia 23, 153–161 (2009). https://doi.org/10.1038/leu.2008.261

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