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. 2024 Oct 8;1(4):100044.
doi: 10.1016/j.bneo.2024.100044. eCollection 2024 Dec.

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

Joshua W D Tobin  1   2 , Venkata A Chikatamarla  2   3   4 , Marko Matic  3 , Alison Griffin  5 , Rakin Chowdhury  1   2 , Ross Salvaris  6 , Amanda Goh  3 , Harrison Black  3 , Tsz Hung Tong  4 , Callum Birks  7 , Sanjiv Jain  8 , Elizabeth Goodall  9 , Shreerang Sirdesai  10 , Thomas Trevis  1 , Elizabeth Steinepreis  11 , Yiyang Chen  12 , Li Li  13 , Glenn Broadby  14 , Naadir Gutta  15 , Kirk Morris  3 , Tara Cochrane  4 , Judith Trotman  7 , Dipti Talaulikar  8   16 , Jake Shortt  6 , Georgina Hodges  1 , Eliza A Hawkes  9 , Chan Y Cheah  17   18 , Allison Barraclough  11 , Kate Manos  12 , Anna Johnston  14 , Jane Royle  19 , Patrizia Mondello  20 , Stephen M Ansell  20 , Greg Hapgood  1   2
Affiliations

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

Joshua W D Tobin et al. Blood Neoplasia. .

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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Conflict of interest statement

Conflict-of-interest disclosure: J.W.D.T. reports research funding from BeiGene, Cellectar, and Janssen. D.T. reports research funding from Janssen and Roche; and honoraria/speaker bureau fees from Roche, Janssen, Takeda, Amgen, CSL, EUSA, and Antengene. C.Y.C. reports honoraria/advisory/consulting fees from Roche, Janssen, Gilead, AstraZeneca, Lilly, BeiGene, Menarini, Dizal, AbbVie, Genmab, Sobi, and Bristol Myers Squibb; and research funding from Bristol Myers Squibb, Roche, AbbVie, MSD, and Lilly. E.H. reports research funding (paid to institution) from Roche, Bristol Myers Squibb, Merck KgA, AstraZeneca, TG Therapeutics, and Merck; consultancy or advisory role fees (paid to institution) from Roche, Merck Sharp & Dohme, AstraZeneca, Gilead, Antengene, Novartis, Regeneron, Janssen, Specialised Therapeutics, and Sobi; and travel expenses from AstraZeneca. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
OS after HRDE. Kaplan-Meier curves of OS-DE in the Ref FL group compared with (A) any HRDE event or (B) clinically defined HRDE subsets.
Figure 2.
Figure 2.
Comparison of baseline PET metrics among HRDE subsets. Violin plots showing the distribution of baseline PET metrics between Ref FL and HRDE (FL24 and early TFL). (A,D) SUVmax, (B,E) TMTV, and (C,F) TLG.
Figure 3.
Figure 3.
OS after biopsy-proven HRDE. Kaplan-Meier curves of OS-RDE comparing Ref FL group with (A) biopsy-proven HRDE subsets and (B) biopsy-proven and clinically defined FL24 groups.
See this image and copyright information in PMC

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