Treatment Patterns and Outcomes in Follicular Lymphoma with POD24: An analysis from the LEO Consortium
Recently an article Jonathan R. Day and colleagues authored was published at blood advances.
Authors: Jonathan R. Day et al.
Researchers have examined how patients with progression of disease within 24 months (POD24) of initial chemoimmunotherapy (IC) for follicular lymphoma (FL) are treated and how they fare in the current era. The study highlights the lack of a standardized treatment approach, the widespread use of aggressive therapies in academic centers, and the poor prognosis for these patients despite these interventions.
To better understand real-world treatment patterns and outcomes, researchers analyzed data from 220 patients using an academic-based cohort from the Lymphoma Epidemiology of Outcomes (LEO) Consortium. Patients were identified from eight U.S. academic centers participating in the LEO Cohort study, as well as institutional databases and the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource.
Patients included had biopsy-confirmed FL (grade 1-3A) diagnosed between 2002 and 2019 and had received initial immunochemotherapy (IC) with either bendamustine-rituximab (BR) or R-CHOP. Those with transformation to diffuse large B-cell lymphoma or high-grade B-cell lymphoma at POD24 were excluded. Clinical data, including treatment details, were collected and analyzed centrally.
Key Findings
- Treatment after POD24 was highly variable, with no single regimen used in more than 25% of cases.
- Among patients initially treated with BR, R-CHOP was the most common second-line choice (48%), while those who received R-CHOP as initial therapy were more likely to receive intensive salvage regimens (38%).
- Response rates to second-line therapy were modest, with an overall response rate (ORR) of 64% and a complete response rate (CRR) of 39%.
- Survival outcomes remained poor: Median event-free survival (EFS) after POD24 was 9.8 months, and five-year overall survival (OS) was 71%. OS was worse for patients >70 years (HR, 2.31) and those with high-risk FLIPI scores at diagnosis (HR, 2.10).
- No specific treatment strategy emerged as superior, and most deaths were lymphoma-related (88% of deaths). However, transformation to aggressive disease was rare (1.1% at five years).
This study underscores the heterogeneity in treatment approaches for POD24 in follicular lymphoma and the lack of a clearly superior second-line strategy.
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