Outcomes for high-risk defining events in follicular lymphoma following frontline immunochemotherapy

Blood Neoplasia Pub Date : 2024-10-08 DOI:10.1016/j.bneo.2024.100044

Joshua W. D. Tobin , Venkata A. Chikatamarla , Marko Matic , Alison Griffin , Rakin Chowdhury , Ross Salvaris , Amanda Goh , Harrison Black , Tsz Hung Tong , Callum Birks , Sanjiv Jain , Elizabeth Goodall , Shreerang Sirdesai , Thomas Trevis , Elizabeth Steinepreis , Yiyang Chen , Li Li , Glenn Broadby , Naadir Gutta , Kirk Morris , Greg Hapgood

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Abstract

Progression of follicular lymphoma (FL) or transformation (TFL) within 24 months of immunochemotherapy (ICT) represent high-risk defining events (HRDE) with poor overall survival (OS). We examined baseline clinical characteristics, imaging, and outcomes for patients experiencing HRDE with newly diagnosed FL requiring ICT. HRDE groups were: relapse or progression of FL within 24 months (FL24), early TFL (transformation <24 months of ICT), late TFL (transformation >24 months of ICT).433 patients were categorized as reference FL (Ref FL), n = 352 (no HRDE); FL24, n = 43; early TFL, n = 29; late TFL, n = 9. Chemotherapy included bendamustine (63%), CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone) (27%), or CVP (cyclophosphamide, vincristine, prednisone) (10%); 85% received rituximab/15% obinutuzumab and 48% received maintenance therapy. Compared with Ref FL group, OS from HRDE was inferior for FL24 (hazard ratio [HR], 3.93; 95% confidence interval [CI], 2.14-7.23), early TFL (HR, 8.16; 95% CI, 4.38-15.2), and late TFL (HR, 8.23; 95% CI, 3.18-21.25). OS from HRDE was inferior for early TFL compared with FL24 (HR, 2.08; 95% CI, 1.02-4.21). In multivariable analysis, performance status, lactate dehydrogenase, beta-2-microglobulin and grade 3A were associated with early TFL. Clinical characteristics did not differentiate early TFL from FL24. Maximum standardized uptake value was higher in early TFL but not FL24 compared to Ref FL. Early TFL and FL24 represent different HRDEs and are associated with inferior OS. Distinguishing early TFL from FL24 is important for biomarker development, management and to develop and interpret trials in this area of unmet need.

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前线免疫化疗后滤泡性淋巴瘤高危定义事件的治疗结果

摘要免疫化疗（ICT）后24个月内滤泡性淋巴瘤（FL）进展或转化（TFL）是高危定义事件（HRDE），总生存率（OS）很低。我们研究了新确诊FL并需要接受ICT治疗的HRDE患者的基线临床特征、影像学检查和预后。HRDE组为：24个月内FL复发或进展（FL24）、早期TFL（ICT 24个月后转化）、晚期TFL（ICT 24个月后转化）。433例患者被分为参考FL（Ref FL），n = 352（无HRDE）；FL24，n = 43；早期TFL，n = 29；晚期TFL，n = 9。化疗包括苯达莫司汀（63%）、CHOP（环磷酰胺、长春新碱、多柔比星、泼尼松）（27%）或CVP（环磷酰胺、长春新碱、泼尼松）（10%）；85%接受利妥昔单抗/15%接受奥比妥珠单抗治疗，48%接受维持治疗。与 Ref FL 组相比，HRDE 的 OS 不如 FL24（危险比 [HR]，3.93；95% 置信区间 [CI]，2.14-7.23）、早期 TFL（HR，8.16；95% CI，4.38-15.2）和晚期 TFL（HR，8.23；95% CI，3.18-21.25）。早期TFL与FL24相比，HRDE的OS较低（HR，2.08；95% CI，1.02-4.21）。在多变量分析中，表现状态、乳酸脱氢酶、β-2-微球蛋白和3A级与早期TFL相关。临床特征并不能区分早期 TFL 和 FL24。与参考 FL 相比，早期 TFL 的最大标准化摄取值更高，而 FL24 则不高。早期TFL和FL24代表不同的HRDE，与较差的OS相关。区分早期TFL和FL24对于生物标志物的开发、管理以及在这一未满足需求领域开展和解释试验非常重要。

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Blood Neoplasia

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