Prognostic significance of bone marrow minimal residual disease in patients with nodal T-follicular helper cell lymphoma

Nodal follicular helper T-cell lymphoma (nTFHL) is an aggressive peripheral T-cell lymphoma with challenging diagnosis and poor prognosis. This study aimed to investigate the clinicopathological characteristics and prognostic factors of nTFHL, with a focus on the role of minimal residual disease (MRD). We conducted a retrospective analysis of 120 patients with nTFHL. Median overall survival (OS) was 30.5 months (5-year OS 25.8%), and median progression-free survival (PFS) was 19.0 months (5-year PFS 16.7%). Univariate analysis identified bone marrow involvement (BMI), serous effusion, CXCL13/BCL-6/EBER positivity, elevated LDH/β2-microglobulin, > 1 extranodal site, and high-risk scores as adverse factors. In BMI patients, persistent MRD+ after first-line therapy correlated with EBER and BCL-6 expression. Notably, among patients achieving radiologic remission but remaining MRD positive, oral maintenance therapy (e.g., chidamide) significantly prolonged OS, PFS, and duration of response compared with no maintenance. Bone marrow MRD is a dynamic biomarker surpassing radiologic assessment; persistent MRD+ predicts early relapse and inferior survival. Integrating multiparameter flow cytometry into routine evaluation is essential for risk stratification, and oral maintenance therapy mitigates the poor prognosis associated with residual disease in nTFHL.