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The Oncologist, Vol. 14, No. suppl_2, 17-29, October 2009; doi:10.1634/theoncologist.2009-S2-17
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Rationale for Consolidation to Improve Progression-Free Survival in Patients with Non-Hodgkin's Lymphoma: A Review of the Evidence

Franck Morschhausera, Martin Dreylingb, Ama Rohatinerc, Fredrick Hagemeisterd, Angelika Bischof Delaloyee

aHôpital Claude Huriez, Lille, France; bKlinikum der Universität München, Munich, Germany; cSt Bartholomew's Hospital, London, United Kingdom; dThe University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA; eCentre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Key Words. Radioimmunotherapy • Consolidation • Lymphoma • Non-Hodgkin's lymphoma • Yttrium-90-ibritumomab tiuxetan • Iodine-131-tositumomab • Complete response

Correspondence: Franck Morschhauser, M.D., Ph.D., Department of Hematology, Hôpital Claude Huriez, F-59037 Lille, France. Telephone: 33-3-20-44-42-90; Fax: 33-3-20-44-47-08; e-mail: f-morschhauser{at}chru-lille.fr

Received March 27, 2009; accepted for publication June 18, 2009.

Disclosures: Franck Morschhauser: Honoraria: Bayer Schering; Martin Dreyling: Honoraria: Roche, Bayer Schering; Research funding/contracted research: Roche, Bayer Schering; Ama Rohatiner: None; Fredrick Hagemeister: Consultant/advisory role: Amgen; Honoraria: Cephalon, Genentech, Biogen Idec; Research funding/contracted research: Novartis; Angelika Bischof Delaloye: Consultant/advisory role: Bayer Schering Pharma AG.

The article discusses 90Y-ibritumomab tiuxetan (Bayer Schering Pharma AG, Spectrum Pharmaceuticals, Inc., Irvine, CA) as consolidation at first remission in follicular lymphoma patients, as a therapy for nonfollicular NHL, and as first-line treatment for NHL patients not eligible for chemotherapy and rituximab (F. Hoffmann-La Roche) as maintenance therapy in previously untreated patients and as treatment for nonfollicular NHL.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

Non-Hodgkin's lymphoma (NHL) comprises both indolent forms, including follicular lymphoma (FL) and marginal zone lymphoma (MZL), and aggressive forms, including diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL). FL and DLBCL are the most common subtypes of indolent and aggressive NHL, respectively. Although these lymphomas exhibit different clinical behaviors and outcomes, the prognosis is negatively affected in both DLBCL and FL by the lack of a complete response (CR) with standard treatment options. The aim of therapy should therefore be achievement of a CR, which is not only associated with longer progression-free survival (PFS) and overall survival times, but is also a prerequisite for a cure, particularly in DLBCL.

Consolidation treatment with radioimmunotherapy (RIT) is an innovative treatment approach to increase CR rates. Phase II studies have indicated promising results with yttrium-90 (90Y)-ibritumomab tiuxetan and iodine-131 (131I)-tositumomab as consolidation following induction therapy for previously untreated patients with advanced FL. More recently, investigators reported a marked increase in CR rates and significant improvements in PFS using standard chemotherapy regimens followed by 90Y-ibritumomab tiuxetan in a phase III randomized trial in patients with previously untreated FL. Data also suggest that RIT may play a role in the treatment of high-risk DLBCL, with encouraging PFS results from a phase II trial of 90Y-ibritumomab tiuxetan consolidation following induction with rituximab plus chemotherapy in elderly patients with previously untreated DLBCL. With the higher CR rates and longer PFS times observed in patients with FL and DLBCL, as well as encouraging early data from MZL and MCL consolidation trials, RIT appears to have an important role in the treatment of patients with NHL.




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