Follicular Lymphoma and Bendamustine

One of the really exciting bits of research from the last few years has been an ongoing study of Bendamustine (aka Treanda) and Rituxan for patients with Follicular Lymphoma and other indolent lymphomas. The study focuses on previously untreated patients, and has been going on for a  few years.

I've written about it before, since the head of the study regularly presents updated results at ASH and other blood cancer-related conferences. One big criticism of the study has been that the researchers have not tried to publish the results. That's important. Presenting at a conference is great, but it's much less formal. Publishing in a science journal means the work will be "peer-reviewed" -- other experts in the field will make sure the data was collected in a good way, and that the results are relaly as good as they seem.

Well, the results are in -- published, finally, by the prestigious medical journal The Lancet. And they're awesome.

The study compared patients taking B + R with those taking the more traditional R-CHOP. The Bendamustine patients had better results (69.5 months of progression-free survival for B + R, versus 31.2 months for R-CHOP), with less toxicity and fewer side effects.

This confirms what we've seemed to know for a few years: Bendamustine is an excellent choice, probably better than CHOP. I started to write "the best choice," but I stopped myself. I'm still OK with watching and waiting (and so are lots of experts), and I'm also OK with straight Rituxan as a first line treatment (and, again, so are lots of experts). But Bendamustine seems like the best choice for later line treatments (though this study is only first line), and for more aggressive Follicular Lymphomas. R-CHOP still seems best for transformed or aggressive FL; I haven't seen anything that suggests otherwise.

Of course, there are caveats and warnings, including one also published in The Lancet: CHOP has been around for a long time, and we have a pretty good sense of its long-term effects. that's not the case with Bendamustine. So we need to keep an eye on things there.

The good news is that we have some confirmation by the Lymphoma community that B + R is as good as we'd hoped.