TY - JOUR
T1 - Treatment patterns and outcomes in follicular lymphoma with POD24
T2 - an analysis from the LEO Consortium
AU - Day, Jonathan R.
AU - Larson, Melissa C.
AU - Durani, Urshila
AU - Koff, Jean L.
AU - Wang, Yucai
AU - Habermann, Thomas M.
AU - Lossos, Izidore S.
AU - Nastoupil, Loretta J.
AU - Strouse, Christopher
AU - Chihara, Dai
AU - Martin, Peter
AU - Leonard, John P.
AU - Cohen, Jonathon B.
AU - Kahl, Brad S.
AU - Ruan, Jia
AU - Burack, W. Richard
AU - Friedberg, Jonathan W.
AU - Cerhan, James R.
AU - Flowers, Christopher R.
AU - Link, Brian K.
AU - Maurer, Matthew J.
AU - Casulo, Carla
N1 - Publisher Copyright:
© 2025 American Society of Hematology. All other rights reserved.
PY - 2025/3/11
Y1 - 2025/3/11
N2 - Progression of disease within 24 months of initial immunochemotherapy (POD24) is a negative prognostic factor for patients with follicular lymphoma (FL). There is no standard treatment after POD24. Assembling an academic-based cohort from the Lymphoma Epidemiology of Outcomes Consortium for Real World Evidence, we evaluated patterns of care and outcomes for 220 patients with FL with POD24 and retained FL histology. Therapy after POD24 was heterogeneous, with no treatment category accounting for >25% of the total. Among patients initially treated with bendamustine-rituximab, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) was the predominant second-line choice (48%). Among patients initially treated with R-CHOP, aggressive salvage therapy was the predominant second-line choice (38%). Overall response rate to therapy after POD24 was 64% (95% confidence interval [CI], 56-70); complete response rate was 39% (95% CI, 32-46). The median event-free survival for therapy after POD24 was 9.8 months (95% CI, 7.3-12.1); 5-year overall survival (OS) was 71% (95% CI, 65-78). OS was inferior for patients aged >70 years (hazard ratio [HR], 2.31; 95% CI, 1.27-4.20) and those with high-risk FL International Prognostic Index scores at diagnosis (HR, 2.10; 95% CI, 1.23-3.60). No treatment category stood out with more favorable results. Cause of death was predominantly lymphoma related. Patients with follicular histology at their POD24 event had a low cumulative incidence of transformation (1.1% at 5 years). Our study is among the largest cohorts describing contemporary patterns of care for patients with POD24, providing a focused data set useful for interpreting and designing prospective clinical trials in this population.
AB - Progression of disease within 24 months of initial immunochemotherapy (POD24) is a negative prognostic factor for patients with follicular lymphoma (FL). There is no standard treatment after POD24. Assembling an academic-based cohort from the Lymphoma Epidemiology of Outcomes Consortium for Real World Evidence, we evaluated patterns of care and outcomes for 220 patients with FL with POD24 and retained FL histology. Therapy after POD24 was heterogeneous, with no treatment category accounting for >25% of the total. Among patients initially treated with bendamustine-rituximab, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) was the predominant second-line choice (48%). Among patients initially treated with R-CHOP, aggressive salvage therapy was the predominant second-line choice (38%). Overall response rate to therapy after POD24 was 64% (95% confidence interval [CI], 56-70); complete response rate was 39% (95% CI, 32-46). The median event-free survival for therapy after POD24 was 9.8 months (95% CI, 7.3-12.1); 5-year overall survival (OS) was 71% (95% CI, 65-78). OS was inferior for patients aged >70 years (hazard ratio [HR], 2.31; 95% CI, 1.27-4.20) and those with high-risk FL International Prognostic Index scores at diagnosis (HR, 2.10; 95% CI, 1.23-3.60). No treatment category stood out with more favorable results. Cause of death was predominantly lymphoma related. Patients with follicular histology at their POD24 event had a low cumulative incidence of transformation (1.1% at 5 years). Our study is among the largest cohorts describing contemporary patterns of care for patients with POD24, providing a focused data set useful for interpreting and designing prospective clinical trials in this population.
UR - https://www.scopus.com/pages/publications/86000326157
U2 - 10.1182/bloodadvances.2024014053
DO - 10.1182/bloodadvances.2024014053
M3 - Article
C2 - 39602301
AN - SCOPUS:86000326157
SN - 2473-9529
VL - 9
SP - 1013
EP - 1023
JO - Blood Advances
JF - Blood Advances
IS - 5
ER -