P047 | A LOW-DOSE VINORELBINE SCHEDULE ACHIEVES LONG-TERM REMISSION IN PATIENTS WITH FOLLICULAR LYMPHOMA EXPERIENCING ADVERSE REACTIONS OR REFRACTORINESS TO LENALIDOMIDE.

Background: Lenalidomide (Lena) combined with anti-CD20 antibody (R2 regimen) is an established therapy for relapsed-refractory B-cell lymphomas. We recently demonstrated that also other cytotoxic drugs, given in a continuous low-dose schedule (mCHEMO) are effective and low-toxic in both B &T cell lymphomas. Aims: to report outcomes of a metronomic schedule based on vinorelbine (VNR) and rituximab in relapsed/refractory FL. Methods: We retrospectively collected data from FL patients treated with a mCHEMO regimen, with or without rituximab, from February 2014 to May 2024 (cut-off: March 2025). DEVEC-light schedule: Induction (6 cycles): Cyclophosphamide (CTX) 50 mg/day (up to 21 days), VNR 30 mg thrice weekly (3 weeks on/1 week off), prednisolone 25 mg thrice weekly, ± anti-CD20 antibody (weekly ×4, then every 4 weeks ×4). Maintenance (6 cycles): CTX 50 mg/day (up to 14 days), VNR and prednisolone as above but with reduced prednisolone frequency. Post-maintenance: VNR alone until progression or toxicity. Prior treatments and outcomes were also recorded. Results: Thirteen patients were included: median age 77 years (range 58–92); 85% had advanced disease; median prior therapies: 3 (range 1–5); POD24 in 61.5%. Before mCHEMO, 54% were refractory to their last treatment. Six patients had discontinued R2 due to toxicity or refractoriness; three were unsuitable for R2; four had no access to R2 at the time. After a median follow-up of 24 months (range 10–129): ORR: 92.3% with mCHEMO vs 63.5% with prior therapies (p=n.s.). CRR: 53.8% vs 27.2% (p=n.s.). Median time to best response: 7 months (2–51). 24-month PFS: 60% vs 35% after prior chemo-immunotherapy (p=0.007). Grade ≥3 adverse events: 2 cases of neutropenia, 1 febrile neutropenia, 1 pneumonia. Notably, 30% of patients converted from partial to complete response during VNR-only maintenance. Conclusions: Metronomic chemotherapy with or without rituximab substantially prolonged PFS. Given its favorable safety, cost-effectiveness, and chemo-free-like profile, DEVEC-light is a promising option for FL, meriting further study, particularly with novel targeted therapies.