Treatment patterns and outcomes in follicular lymphoma with POD24: an analysis from the LEO Consortium

Progression of disease within 24 months of initial immunochemotherapy (POD24) is a negative prognostic factor for patients with follicular lymphoma (FL). There is no standard treatment after POD24. Assembling an academic-based cohort from the Lymphoma Epidemiology of Outcomes Consortium for Real World Evidence, we evaluated patterns of care and outcomes for 220 patients with FL with POD24 and retained FL histology. Therapy after POD24 was heterogeneous, with no treatment category accounting for >25% of the total. Among patients initially treated with bendamustine-rituximab, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) was the predominant second-line choice (48%). Among patients initially treated with R-CHOP, aggressive salvage therapy was the predominant second-line choice (38%). Overall response rate to therapy after POD24 was 64% (95% confidence interval [CI], 56-70); complete response rate was 39% (95% CI, 32-46). The median event-free survival for therapy after POD24 was 9.8 months (95% CI, 7.3-12.1); 5-year overall survival (OS) was 71% (95% CI, 65-78). OS was inferior for patients aged >70 years (hazard ratio [HR], 2.31; 95% CI, 1.27-4.20) and those with high-risk FL International Prognostic Index scores at diagnosis (HR, 2.10; 95% CI, 1.23-3.60). No treatment category stood out with more favorable results. Cause of death was predominantly lymphoma related. Patients with follicular histology at their POD24 event had a low cumulative incidence of transformation (1.1% at 5 years). Our study is among the largest cohorts describing contemporary patterns of care for patients with POD24, providing a focused data set useful for interpreting and designing prospective clinical trials in this population.

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Publication Details

Journal
Blood Advances
Published
2024-11-27
DOI
https://doi.org/10.1182/bloodadvances.2024014053
Citations
7
Primary Topic
Lymphoma Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
2.97

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article

Treatment patterns and outcomes in follicular lymphoma with POD24: an analysis from the LEO Consortium

Christopher Sun Strouse, Richard Burack, Jonathon Brett Cohen, Thomas Matthew Habermann et al.
7 citations
Blood Advances
Lymphoma Diagnosis and Treatment
2.97
article

Treatment patterns and outcomes in follicular lymphoma with POD24: an analysis from the LEO Consortium

Christopher Sun Strouse, Richard Burack, Jonathon Brett Cohen, Thomas Matthew Habermann, Urshila Durani, Loretta J. Nastoupil, John P. Leonard, Jonathan W. Friedberg, Jonathan R Day, Izidore S. Lossos, Jia Ruan, Dai Chihara, Matthew J. Maurer, Carla Casulo, Brad S. Kahl, James R. Cerhan, Christopher R. Flowers, Brian K. Link, Jean Louise Koff, Yucai Wang, Melissa C. Larson, Peter Martin
article en
7 citations

Abstract

Progression of disease within 24 months of initial immunochemotherapy (POD24) is a negative prognostic factor for patients with follicular lymphoma (FL). There is no standard treatment after POD24. Assembling an academic-based cohort from the Lymphoma Epidemiology of Outcomes Consortium for Real World Evidence, we evaluated patterns of care and outcomes for 220 patients with FL with POD24 and retained FL histology. Therapy after POD24 was heterogeneous, with no treatment category accounting for >25% of the total. Among patients initially treated with bendamustine-rituximab, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) was the predominant second-line choice (48%). Among patients initially treated with R-CHOP, aggressive salvage therapy was the predominant second-line choice (38%). Overall response rate to therapy after POD24 was 64% (95% confidence interval [CI], 56-70); complete response rate was 39% (95% CI, 32-46). The median event-free survival for therapy after POD24 was 9.8 months (95% CI, 7.3-12.1); 5-year overall survival (OS) was 71% (95% CI, 65-78). OS was inferior for patients aged >70 years (hazard ratio [HR], 2.31; 95% CI, 1.27-4.20) and those with high-risk FL International Prognostic Index scores at diagnosis (HR, 2.10; 95% CI, 1.23-3.60). No treatment category stood out with more favorable results. Cause of death was predominantly lymphoma related. Patients with follicular histology at their POD24 event had a low cumulative incidence of transformation (1.1% at 5 years). Our study is among the largest cohorts describing contemporary patterns of care for patients with POD24, providing a focused data set useful for interpreting and designing prospective clinical trials in this population.

Blood AdvancesVol. 9(5)
University of Iowa (US), Mayo Clinic (US), NewYork–Presbyterian Hospital (US), The University of Texas MD Anderson Cancer Center (US), University of Miami (US), Emory University (US), Washington University in St. Louis (US), Cornell University (US), New York Hospital Queens (US), WinnMed (US), University of Rochester Medical Center (US), Presbyterian Hospital (US), University of Miami Health System (US), Mayo Clinic in Florida (US), Sylvester Comprehensive Cancer Center (US), Weill Cornell Medicine (US), University of Rochester (US)
National Cancer Institute
Good health and well-being
Openalex Percentile: Top 8%
Lymphoma Diagnosis and Treatment
2.97
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