Obinutuzumab Plus Chemotherapy As First Line Treatment in Patients with Follicular Lymphoma: Experience from a Community Hospital

Abstract

Background The combination of Obinutuzumab plus chemotherapy (Obi-chemo) regimen is currently one of the standard first-line treatments available for patients diagnosed with follicular non-Hodgkin's lymphoma (FL). The aim of our study is to evaluate the efficacy and safety of the Obi-chemo regimen in a community hospital setting. Methods Retrospective analysis of patient's medical records admitted to our hospital with a confirmed pathologic diagnosis of FL that were treated with the regimen of Obi-chemo as first-line treatment. Between January 1, 2017 and January 5, 2022, a total of 10 consecutive patients met the criteria for evaluation. Results The baseline characteristics of the patients evaluated are as follows: The group consisted of 7 males and 3 females. Median age in years was 56 (range 43-80). 10% (n=1) patients had stage 2, and the remaining 90% (n=9) had stage III-IV. Bone marrow involvement was noted in 70% (n=7) and 40% (n=4) had bulky mass >7 cm at presentation. Of the total ten patients, 60% (n=6) received Obinutuzumab plus Bendamustine and the remaining 40% (n=4) received Obinutuzumab plus CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone). All patients required G-CSF support. After completion of chemotherapy, 7 patients achieved a complete clinical and radiologic remission whereas 3 patients achieved a partial remission. Of these last 3 patients, two went on to achieve a complete remission during follow-up. Of the 7 patients who achieved an initial complete remission, one subsequently did relapse during follow-up. While on treatment, neutropenia and thrombocytopenia were documented in all 10 patients. 40% (n=4) of patients developed neutropenic fever, and 10% (n=1) developed grade 3 thrombocytopenia. 50% (n=5) of patients developed grade 1-2 infusion-related adverse events (nausea, hypertension, headache and skin rash). Two patients required chemotherapy de-escalation due to toxicity. No long-term toxicity or treatment-related deaths were reported. Conclusions Our study supports the findings of the pivotal clinical trials that led to the approval of the Obi-chemo antineoplastic regimen as first-line treatment for patients with FL by the regulatory agencies in Europe (EMA) and North America (FDA).