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

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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Journal
Blood Advances
Published
2025-03-19
DOI
https://doi.org/10.1182/bloodadvances.2024014790
Citations
2
Primary Topic
Lymphoma Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
2.94
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article

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

Fabrizio Bergesio, Luca Guerra, Filippo Ballerini, Roberto Freilone et al.
2 citations
Blood Advances
Lymphoma Diagnosis and Treatment
2.94
article

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

Fabrizio Bergesio, Luca Guerra, Filippo Ballerini, Roberto Freilone, Stefano Luminari, Patrizia Tosi, Alessia Bari, Antonio Pinto, Ilaria Del Giudice, Marta Coscia, Arcangelo Liso, Annibale Versari, Stéphane Chauvie, Paolo Corradini, Leonardo Flenghi, Rexhep Durmo, Michele Merli, Federico Fallanca, Jacopo Olivieri, Emanuele Angelucci, Luigi Marcheselli, Silvia Bolis, Domenico Pastore, Pier Luigi Zinzani
article en
2 citations

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.

Blood AdvancesVol. 9(12)
University of Insubria (IT), University of Modena and Reggio Emilia (IT), University of Milan (IT), University of Perugia (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), San Raffaele University of Rome (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale Maggiore (IT), Azienda Ospedaliera di Perugia (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Ospedale A. Perrino (IT), Azienda Ospedaliera San Gerardo (IT), Istituto di Ematologia di Bologna (IT), Ospedale Santa Maria della Misericordia di Udine (IT), Azienda Socio Sanitaria Territoriale Lariana (IT), Fondazione Intergruppo Italiano Linfomi Onlus (IT), Ospedale Infermi di Rimini (IT), Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT), Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT), Tumori Foundation (US), Ospedale Policlinico San Martino (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), ASM Terni (Italy) (IT), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Azienda Sanitaria Universitaria Integrata di Trieste (IT), University of Turin (IT), University of Milano-Bicocca (IT), University of Genoa (IT), Sapienza University of Rome (IT), University of Bologna (IT)
Good health and well-being
Openalex Percentile: Top 11%
Lymphoma Diagnosis and Treatment
2.94
DOIOpen Access PDFOpenAlex
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