Treatment and Survival Outcomes in Follicular Lymphoma Patients with POD24: A Systematic Review and Meta-Analysis

Follicular lymphoma (FL) with progression within 24 months (POD24) is associated with poor prognosis and represents clinical challenges. Therefore, we performed a systematic review and pooled analysis of patients with POD24. Twenty-one trials involving 1242 participants were included, assessing the overall response rate (ORR), complete response (CR), duration of response (DOR), and progression-free survival (PFS). In some trials we compared pooled response rates between POD24 and non-POD24 populations with the same treatment regimen. Four trials have evaluated chimeric antigen receptor (CAR) T-cell therapy in patients with POD24. Upon pooled analysis, ORR was 91.2% (95% CI: 83.7-98.7%) with significant heterogeneity (P=0.0414, I²=68.61%), and CR was 75.7% (95% CI: 55.1-96.4%) with significant heterogeneity (P<0.0001, I²=93.99%). The specific response rates for different bispecific antibodies (BsAbs) in POD24 were pooled analysis, the ORR was 81.6% (95% CI: 75.9-87.3%) with no heterogeneity (P=0.6958, I²=0%), and CR was 65.7% (95% CI: 57.1-74.3%) with moderate heterogeneity (P=0.2148 I²=34.99%). Anti-CD19 antibody-drug conjugates (ADCs)/ monoclonal antibody (mAb): the ORR and CR of Loncastuximab+ rituximab and Tafasitamab+R2 (lenalidomide+rituximab) were 100%, 79.3% and 87.5%, 43.2%, respectively. phosphatidylinositol 3-kinase (PI3K) inhibitors and anti-CD20 mAb-containing regimens were also pooled analysis. Our results demonstrated that anti-CD19 CAR-T therapy achieved the highest complete response rate. Additionally, bispecific antibodies, anti-CD19 ADC/mAb, and the combination of lenalidomide with obinutuzumab or rituximab also exhibited excellent efficacy. Notably, lenalidomide plus obinutuzumab showed superior efficacy compared to R2.