Consolidation treatment with Y 90 Ibritumomab Tiuxetan after R-CHOP induction in high-risk patients with Follicular Lymphoma (FL) (GOTEL-FL1LC): a multicentric,

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Consolidation treatment with Y 90 Ibritumomab Tiuxetan after R-CHOP induction in high-risk patients with Follicular Lymphoma (FL) (GOTEL-FL1LC): a multicentric, prospective study Relapse is the main cause of therapeutic failure in follicular lymphoma (FL). We set out to evaluate the role of consolidation with Y 90 -Ibritumomab Tiutexan (RIT) in high risk FL patients. We designed a phase II study with RIT after four cycles of CHOP-R and two CHOP, but without Rituximab. This study was registered with ClinicalTrials.gov Identifier NCT , and European EudraCT number and was conducted within the GOTEL, a cooperative group set up by a network of Medical Oncology Services in Spain.( 30 patients were included from April 2008 and April Patient eligibility: Inclusion criteria: Patients over 18 years old with biopsy-proven, untreated, stage II, III or stage IV follicular non-Hodgkin Lymphoma CD20+, grade I, II, or III, PS 0-1. All patients required absolute granulocyte count ≥1500 x 10 6 /L and a platelet count ≥100,000 x 10 6 /L prior to each cycle. Exclusion criteria: HIV positive, central nervous system involvement, history of prior chemotherapy, radiotherapy or immunotherapy, coexistent serious cardiac disease or a prior malignancy. Treatment plan: Patients were treated with standard CHOP-R every 21 days for 4 cycles. Response assessments was evaluated 4 to 8 weeks after completion of the fourth cycle. Patients achieving at least an unconfirmed partial response were eligible for being treated with two cycles with CHOP (without rituximab) and RIT. Dose Y 90 -Ibritumomab: 0.4 mCi/Kg if granulocyte was ≥1500 x 10 6 /L and platelet > x 10 6 /L, and < 25% bone marrow involvement or 0.3 mCi/Kg if platelet were more than x 10 6 /L but less than x 10 6 /L, (max. 32 mCi) Overall and progression-free survival curves were plotted by the method of Kaplan and Meier and logrank test. An independent data monitoring committee reviewed safety and efficacy data. The objective rate of clinical response was 92.1% (CI 95%: %). Of the 18 patients who presented partial remission to induction treatment, 11 (61.1%) had complete response after consolidation treatment. There was only one exitus due to H1N1 viral pneumonia. The most important G3/4 toxicity was hematological, with 46% thrombopenia and 56% neutropenia. None of the patients in the trial died because of FL. With median follow-up of 26 months (13-40), the mean for disease-free survival or overall survival were not reached. The optimal treatment of advanced/high risk FL remains to be determined. With the addition of immunotherapy and radioimmunotherapy, the overall and complete response rates have improved. In our study, with median follow-up of 26 months, we have good results but much longer follow-up will be necessary to determine the durability of these responses Patients and methods Conclusions M Provencio ; MA Cruz, J Gómez-Codina, C Quero Blanco; M Llanos, FR García Arroyo, L de la Cruz, J Gumá, JR Delgado, R Alvarez, A Rueda. On behalf of the GOTEL (Spanish Lymphoma Oncology Group). Corresponding mail: Patients characteristics Graphical Results YES NO CharacteristicNº% Gender Male Female Histologic grade FLIPI risk Low Intermediate High FLIPI factors >60 years LDH elevated Hb <12 g/dL Stage III-IV >4 affected regions Clinical Outcomes Tiempo (meses) Probabilidad Progression Free Survival Probability Overall Survival 1073P