Rapid and sustained clearance of circulating lymphoma cells after chemotherapy plus rituximab: Clinical significance of quantitative t(14;18) PCR monitoring in advanced stage follicular lymphoma patients

Summary This study of first-line treatment in advanced-stage follicular lymphoma patients analysed the effects of MCP (mitoxantrone, chlorambucil and prednisolone) chemotherapy alone or in combination with rituximab (R-MCP) on circulating lymphoma cells (CLC) and assessed the prognostic value of a quantitative monitoring of CLC. CLC numbers were determined by quantitative polymerase chain reaction (PCR) for the t(14;18)-translocation or by allele-specific PCR for rearranged immunoglobulin heavy chain genes. We analysed blood samples from 43 patients treated in a randomized trial comparing eight cycles of MCP versus R-MCP. Clearance of CLC at the end of therapy was achieved in 21/25 patients (84%) treated with R-MCP compared with 0/18 after MCP alone (P < 0·0001). A ≥2 log CLC reduction was associated with a favourable clinical response (P = 0·0004) and prolonged event-free survival (P = 0·02). In R-MCP patients, stable CLC numbers or consistently PCR-negative blood samples were associated with a continuing clinical remission whereas in two patients a relapse was preceded by a ≥2 log CLC increase. This study demonstrated that R-MCP led to a rapid and sustained eradication of CLC and a ≥2 log CLC reduction was associated with a superior quality and duration of the clinical response.