Surveillance Strategies in Follicular Non-Hodgkin’s Lymphoma’s Using Molecular and Genetic Markers Improve Cost-efficiencies Over Routine Imaging Studies

Follicular lymphoma is the most common indolent non-Hodgkin's lymphoma subtype. Newer therapies have improved outcomes leading to longer survival in 80% of follicular lymphomas. Only 20% patients have either early relapses or undergo transformation to more aggressive forms. Hence, using routine surveillance strategies for all follicular lymphomas is not likely to be cost-effective. Prior prognostication models, including IPI, FLIPI, and FLIPI 2 have limitations in predicting the behavior of these subtypes. Attempts have been therefore made to improve their ability to characterize follicular lymphomas that are likely to have adverse outcomes. These newer models improve upon clinical outcome indicators by adding molecular and genetic markers. These include PRIMA23, ICA13 (Independent Component Analysis 13), and POD24-PI (Progression of Disease Within 24 Months-Prognostic Index). These augmented prognostic models increase the sensitivity and specificity of predicting adverse pathologic behavior. In this paper we look at prevalence of these molecular and genetic markers before treatment and then looked for their presence in patients who experienced early relapses to define their utility in developing selective surveillance strategies. Over 10 molecular and genetic markers were uniquely present in patients who relapsed and these were also different from those who had disease transformation. These markers likely indicate clonal remnants that evade initial treatment causing early relapses. A selective surveillance strategy is therefore possible using molecular and genetic markers. This will help create a more cost-effective surveillance strategy in patients with follicular lymphomas.