***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We evaluated the role of rituximab ( R ) both in remission induction and maintenance treatment of relapsed/resistant follicular lymphoma ( FL ) . A total of 465 patients were r and omized to induction with 6 cycles of cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) ( every 3 weeks ) or R-CHOP ( R : 375 mg/m(2 ) intravenously , day 1 ) . Those in complete remission ( CR ) or partial remission ( PR ) were r and omized to maintenance with R ( 375 mg/m(2 ) intravenously once every 3 months for a maximum of 2 years ) or observation . R-CHOP induction yielded an increased overall response rate ( CHOP , 72.3 % ; R-CHOP , 85.1 % ; P < .001 ) and CR rate ( CHOP , 15.6 % ; R-CHOP , 29.5 % ; P < .001 ) . Median progression-free survival ( PFS ) from first r and omization was 20.2 months after CHOP versus 33.1 months after R-CHOP ( hazard ratio [ HR ] , 0.65 ; P < .001 ) . Rituximab maintenance yielded a median PFS from second r and omization of 51.5 months versus 14.9 months with observation ( HR , 0.40 ; P < .001 ) . Improved PFS was found both after induction with CHOP ( HR , 0.30 ; P < .001 ) and R-CHOP ( HR , 0.54 ; P = .004 ) . R maintenance also improved overall survival from second r and omization : 85 % at 3 years versus 77 % with observation ( HR , 0.52 ; P = .011 ) . This is the first trial showing that in relapsed/resistant FL rituximab maintenance considerably improves PFS not only after CHOP but also after R-CHOP induction BACKGROUND Neither chemotherapy with a single-alkylating agent nor aggressive combination chemotherapy cures advanced stage low- grade non-Hodgkin lymphomas , even when combined with radiotherapy . Our aim was to compare administration of immediate chlorambucil treatment with a policy of delaying chlorambucil until clinical progression necessitated its use , in asymptomatic patients with advanced-stage , low- grade non-Hodgkin lymphoma . METHODS 309 patients with asymptomatic , advanced-stage , low- grade non-Hodgkin lymphomas were recruited from 44 UK centres between Feb 1 , 1981 , and July 31 , 1990 . 158 patients were r and omised to receive immediate systemic therapy with oral chlorambucil 10 mg per day continuously . The remaining 151 were r and omised to an initial policy of observation , with systemic therapy delayed until disease progression . In both groups , local radiotherapy to symptomatic nodes was allowed . FINDINGS Median length of follow-up was 16 years . Overall survival or cause-specific survival did not differ between the two groups ( median overall survival for oral chlorambucil 5.9 [ range 0 - 17.8 ] years and for observation 6.7 [ 0.5 - 18.9 ] years , p=0.84 ; median cause-specific survival 9 [ 0 - 17.8 ] years and 9.1 [ 0.67 - 18.9 ] years , respectively p=0.44 ) . In a multivariate analysis , age younger than 60 years , erythrocyte sedimentation rate ( ESR ) 20 mm/h or less , and stage III disease , conferred significant advantages in both overall survival ( p<0.0001 , 0.03 , and 0.03 , respectively ) and cause-specific survival ( p=0.002 , 0.008 , and 0.001 , respectively ) . In the observation group , at 10 years ' follow-up , 19 patients were alive and had not received chemotherapy . The actuarial chance of not needing chemotherapy ( non-lymphoma deaths censored ) at 10 years was 19 % ( 40 % if older than 70 years ) . INTERPRETATION An initial policy of watchful waiting in patients with asymptomatic , advanced stage low- grade non-Hodgkin lymphoma is appropriate , especially in patients older than age 70 years PURPOSE The CD20 antigen is expressed on more than 90 % of B-cell lymphomas . It is appealing for targeted therapy , because it does not shed or modulate . A chimeric monoclonal antibody more effectively mediates host effector functions and is itself less immunogenic than are murine antibodies . PATIENTS AND METHODS This was a multiinstitutional trial of the chimeric anti-CD20 antibody , IDEC-C2B8 .  Patients with relapsed low grade or follicular lymphoma received an outpatient treatment course of IDEC-C2B8 375 mg/m2 intravenously weekly for four doses . RESULTS From 31 centers , 166 patients were entered . Of this intent-to-treat group , 48 % responded . With a median follow-up duration of 11.8 months , the projected median time to progression for responders is 13.0 months . Serum antibody levels were sustained longer after the fourth infusion than after the first , and were higher in responders and in patients with lower tumor burden . The majority of adverse events occurred during the first infusion and were grade 1 or 2 ; fever and chills were the most common events . Only 12 % of patients had grade 3 and 3 % grade 4 toxicities . A human antichimeric antibody was detected in only one patient . CONCLUSION The response rate of 48 % with IDEC-C2B8 is comparable to results with single-agent cytotoxic chemotherapy .  Toxicity was mild . Attention needs to be paid to the rate of antibody infusion , with titration according to toxicity . Further investigation of this agent is warranted , including its use in conjunction with st and ard chemotherapy PURPOSE Advanced-stage follicular lymphoma is considered incurable . The pace of improvements in treatment has been slow . This article analyzes five sequential cohorts of patients with stage IV follicular lymphoma treated between 1972 and 2002 . METHODS Five consecutive studies ( two were r and omized trials ) involving 580 patients were analyzed for overall survival ( OS ) , failure-free survival ( FFS ) , and survival after first relapse . A proportional hazards analysis , and subset analyses using the follicular lymphoma international prognostic index ( FLIPI ) score were performed . Treatment regimens included : cyclophosphamide , doxorubicin , vincristine , prednisone , bleomycin ( CHOP-Bleo ) ; CHOP-Bleo followed by interferon alfa ( IFN-alpha ) ; a rotation of three regimens ( alternating triple therapy ) , followed by IFN-alpha ; fludarabine , mitoxantrone , dexamethasone ( FND ) followed by IFN-alpha ; and FND plus delayed versus concurrent rituximab followed by IFN-alpha . RESULTS Improvements in 5-year OS ( from 64 % to 95 % ) and FFS ( from 29 % to 60 % ) indicate steady progress , perhaps partly due to more effective salvage therapies , but the FFS data also indicate improved front-line therapies ; these observations held true after controlling for differences in prognostic factors among the cohorts . The FLIPI model adds rigor to and facilitates comparisons among the different cohorts . An unexpected finding in this study was a trend toward an apparent FFS plateau . CONCLUSION Evolving therapy , including the incorporation of biologic agents , has led to stepwise significant outcome improvements for patients with advanced-stage follicular lymphoma . The apparent plateau in the FFS curve , starting approximately 8 to 10 years from the beginning of treatment , raises the issue of the potential curability of these patients PURPOSE To assess the outcome of high-dose therapy with autologous stem-cell support in patients with histologic transformation of low- grade follicular non-Hodgkin 's lymphoma ( NHL ) and identify significant prognostic factors , as well as to compare survival of these patients with that of patients with matched low- grade and de novo high- or intermediate- grade NHL undergoing the same procedure . PATIENTS AND METHODS Fifty patients with transformed low- grade NHL have been reported to the European Bone Marrow Transplant registry . Outcome from high-dose therapy and significant prognostic factors were analyzed . Their survival was also compared with that of 200 patients with matched low- grade NHL and 200 patients with matched de novo high- or intermediate- grade NHL by a case-matched analysis . RESULTS The procedure-related death rate among the 50 transformed NHL patients was 18 % . Overall survival ( OS ) and progression-free survival ( PFS ) rates were 51 % and 30 % at 5 years , respectively . Median PFS time was 13 months . Raised lactate dehydrogenase levels at transformation ( P = .0031 ) was identified as the only adverse significant predictor of PFS on multivariate analysis . A subgroup of patients with residual chemosensitive disease who attained complete remission after high-dose therapy had the best outcome , with an OS at 5 years of 69 % . A comparison with matched patients with low- grade disease and with de novo high- or intermediate- grade lymphoma showed no significant difference in OS ( P = .939 and P = .438 , respectively ) . CONCLUSION Patients with chemosensitive transformed lymphoma should be seriously considered for high-dose therapy and autologous stem-cell support The combination of cyclophosphamide , vincristine , and prednisone ( CVP ) is one of several st and ard treatment options for advanced follicular lymphoma . This , like similar chemotherapeutic regimens , induces response rates of 60 % to 80 % , with a median response duration of under 2 years . Rituximab , a chimeric monoclonal antibody against CD20 , is active in follicular lymphoma , both as monotherapy and in combination with chemotherapy . Previously untreated patients with stages III to IV follicular lymphoma were r and omly assigned to receive either 8 cycles of CVP plus rituximab ( R-CVP ; n = 162 ) or CVP ( n = 159 ) .  Overall and complete response rates were 81 % and 41 % in the R-CVP arm versus 57 % and 10 % in the CVP arm , respectively ( P < .0001 ) . At a median follow-up of 30 months , patients treated with R-CVP had a very significantly prolonged time to progression ( median 32 months versus 15 months for CVP ; P < .0001 ) . Median time to treatment failure was 27 months in patients receiving R-CVP and 7 months in the CVP arm ( P < .0001 ) . Rituximab did not add significantly to the toxicity of CVP . The addition of rituximab to the CVP regimen significantly improves the clinical outcome in patients with previously untreated advanced follicular lymphoma , without increased toxicity PURPOSE To determine the safety and efficacy of the combination of the chimeric anti-CD20 antibody , Rituxan ( Rituximab , IDEC-C2B8 ; IDEC Pharmaceuticals Corporation , San Diego , CA ) , and cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) chemotherapy . PATIENTS AND METHODS Forty patients with low- grade or follicular B-cell non-Hodgkin 's lymphoma received six infusions of Rituxan ( 375 mg/m2 per dose ) in combination with six doses of CHOP chemotherapy . RESULTS The overall response rate was 95 % ( 38 of 40 patients ) . Twenty-two patients experienced a complete response ( 55 % ) , 16 patients had a partial response ( 40 % ) , and two patients , who received no treatment , were classified as nonresponders . Medians for duration of response and time to progression had not been reached after a median observation time of 29 + months . Twenty-eight of 38 assessable patients ( 74 % ) continued in remission during this median follow-up period . The most frequent adverse events attributable to CHOP were alopecia ( 38 patients ) , neutropenia ( 31 patients ) , and fever ( 23 patients ) . The most frequent events attributed to Rituxan were fever and chills , observed primarily with the first infusion . No quantifiable immune response to the chimeric antibody was detected . In a subset of 18 patients , the bcl-2 [ t(14;18 ) ] translocation was positive in eight patients ; seven of these patients had complete remissions and converted to polymerase chain reaction ( PCR ) negativity by completion of therapy . CONCLUSION This is the first report demonstrating the safety and efficacy of Rituxan anti-CD20 chimeric antibody in combination with st and ard-dose systemic chemotherapy in the treatment of indolent B-cell lymphoma . The clinical responses suggest an additive therapeutic benefit for the combination with no significant added toxicity . The conversion of bcl-2 from positive to negative by PCR in blood and /or marrow suggests possible clearing of minimal residual disease not previously demonstrated by CHOP chemotherapy alone PURPOSE To evaluate prospect ively in patients with follicular lym 
    Output:
    
In patients with indolent or mantle cell lymphoma , R-chemo is superior to chemotherapy alone with respect to overall survival