Chemo-Free Therapy for Follicular Lymphoma

Immunochemotherapy has been the standard of care for high-tumor-burden, symptomatic patients with follicular lymphoma (FL) for many years.

Now, investigators have conducted an industry-sponsored, international, randomized, superiority phase III trial (RELEVANCE) to compare the efficacy and safety of induction therapy with the noncytotoxic combination of rituximab plus lenalidomide (R-Len) versus standard rituximab (R) plus chemotherapy (R-chemo; investigator's choice of R-CVP, R-CHOP, or R-bendamustine) in 1030 treatment-naive FL patients. Following completion of induction, maintenance therapy was administered for 2 years in each treatment arm. The primary endpoints were complete remission (CR) at 120 weeks and progression-free survival (PFS).

Results at a median follow-up of 38 months were as follows:

• CR was similar with R-Len versus R-chemo (48% and 53%, respectively), as were 3-year PFS (77% and 78%), overall survival (OS; 94%), and 2-year event-free survival.
• Grade 3 or 4 rash was more common with R-Len, whereas grade 4 neutropenia was more common with R-chemo; growth factor support was administered in 23% of R-Len recipients and 68% of R-chemo recipients.
• Death occurred in 1% of patients in each arm, and second primary cancers occurred in 7% of R-Len recipients and 10% of R-chemo recipients.
• Response to R-Len was unrelated to FL prognostic factors, whereas response to R-chemo was better in lower-risk patients.