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Randomized Controlled Trial
. 2025 Jun 24;9(12):2927-2934.
doi: 10.1182/bloodadvances.2024014790.

Prognostic role of interim PET in follicular lymphoma: a post hoc study of FOLL12 trial by Fondazione Italiana Linfomi

Rexhep Durmo  1 , Stephane Chauvie  2 , Federico Fallanca  3 , Fabrizio Bergesio  2 , Antonio Pinto  4 , Ilaria Del Giudice  5 , Marta Coscia  6 , Paolo Corradini  7 , Emanuele Angelucci  8 , Patrizia Tosi  9 , Roberto Freilone  10 , Filippo Ballerini  11 , Alessia Bari  12 , Domenico Pastore  13 , Pier Luigi Zinzani  14   15 , Silvia Bolis  16 , Leonardo Flenghi  17 , Arcangelo Liso  18 , Jacopo Olivieri  19 , Luigi Marcheselli  20 , Michele Merli  21 , Annibale Versari  1 , Luca Guerra  22   23 , Stefano Luminari  24   25
Affiliations
Randomized Controlled Trial

Prognostic role of interim PET in follicular lymphoma: a post hoc study of FOLL12 trial by Fondazione Italiana Linfomi

Rexhep Durmo et al. Blood Adv. .

Abstract

We analyzed metabolic response using interim positron emission tomography scan (iPET) in a subset of patients with follicular lymphoma (FL) enrolled in the randomized FOLL12 trial. Patients with grade 1-3a FL with an iPET performed between cycles 4 and 5 of first-line immunochemotherapy (ICT) were included; PET scan had to be centrally reviewed for the definition of Deauville score (DS) and were considered positive for DS 4-5. Overall 123 patients out of 211 with iPET were available for central review. Of these, 43% were older than 60, 33% had high-risk FLIPI2, and 47% received rituximab-bendamustine as the induction regimen. iPET showed a complete metabolic response (CMR) in 83% of cases. CMR at the end-of-induction therapy PET scan (eoiPET) was confirmed in 91% of iPET-negative patients. The 5-year progression-free survival (PFS) was 70% for iPET-negative and 34% for iPET-positive cases. In multivariate analysis, positive iPET was an independent prognostic factor for PFS. Combining iPET and eoiPET, the 3-year PFS was 78% for both negative iPET and eoiPET, with a reduced risk of progression compared to double-positive iPET/eoiPET cases. The 5-year overall survival rate was 96% for iPET-negative and 85% for DS 4-5. Our results confirm that iPET in patients with FL treated with standard ICT is a strong prognostic factor. Assessment of early metabolic response in FL may be considered for defining a novel generation of early response-adapted trials in FL. This trial was registered at www.ClinicalTrials.gov as #NCT02063685.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Evolution of DS from interim to end of treatment assessment. Alluvial plot includes 118 patients paired by iDS and eoiDS (5 patients in iDS were excluded, 2 with iDS 1-3 and 3 with iDS 4-5). 3-y fail. prob, 3-year probability of failure.
Figure 2.
Figure 2.
PFS according to iPET results.
Figure 3.
Figure 3.
PFS according to iPET for randomized arm and induction therapy.
Figure 4.
Figure 4.
PFS according to combination of iPET and eotPET.
Figure 5.
Figure 5.
OS according to iPET.
See this image and copyright information in PMC

References

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