Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada.
Blood. 2019 Aug 29;134(9):761-764. doi: 10.1182/blood.2019000258. Epub 2019 Jul 12.
Despite widespread use of bendamustine and rituximab (BR) as frontline therapy for advanced-stage follicular lymphoma (FL), little is known about the risk of early progression or incidence of histological transformation. We performed a retrospective analysis of a population-based cohort of 296 patients with advanced-stage FL treated with frontline BR and maintenance rituximab. As previously demonstrated, outcomes with this regimen are excellent, with 2-year event-free survival estimated at 85% (95% confidence interval [95% CI], 80-89) and 2-year overall survival 92% (95% CI, 88-95). Progression of disease within 24 months (POD24) occurred in 13% of patients and was associated with a significantly inferior outcome with 2-year overall survival of 38% (95% CI, 20-55). The only significant risk factor for POD24 at baseline was elevated lactate dehydrogenase ( < .001). Importantly, the majority of POD24 patients (76%) had transformed disease. Compared with a historical cohort treated with rituximab, cyclophosphamide, vincristine, and prednisone, event-free survival has improved and the risk of POD24 has decreased, but a higher proportion of patients with POD24 harbor transformation. The overall incidence of transformation appears unchanged. The presence of occult or early transformation is the main driver of POD24 in FL patients treated with frontline BR. Identification of biomarkers and improved management strategies for transformation will be crucial to improving outcomes.
尽管苯达莫司汀和利妥昔单抗（BR）广泛用于滤泡性淋巴瘤（FL）的晚期一线治疗，但对于早期进展或组织学转化的风险知之甚少。我们对接受一线 BR 联合维持性利妥昔单抗治疗的 296 例晚期 FL 患者进行了基于人群的回顾性分析。正如之前所证明的，该方案的疗效非常好，2 年无事件生存率估计为 85%（95%置信区间[95%CI]，80-89），2 年总生存率为 92%（95%CI，88-95）。24 个月内（POD24）疾病进展发生在 13%的患者中，与 2 年总生存率明显较差相关，为 38%（95%CI，20-55）。POD24 的唯一显著基线风险因素是乳酸脱氢酶升高（<0.001）。重要的是，大多数 POD24 患者（76%）发生了转化疾病。与接受利妥昔单抗、环磷酰胺、长春新碱和泼尼松治疗的历史队列相比，无事件生存率有所提高，POD24 的风险降低，但 POD24 患者中转化的比例更高。转化的总体发生率似乎保持不变。隐匿性或早期转化的存在是接受一线 BR 治疗的 FL 患者 POD24 的主要驱动因素。识别转化的生物标志物和改进的管理策略对于改善结局至关重要。
