Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA.
Department of Medicine, The Ohio State University, Columbus, Ohio, USA.
Hematol Oncol. 2024 May;42(3):e3278. doi: 10.1002/hon.3278.
Follicular lymphoma (FL) is the most common indolent B-cell non-Hodgkin lymphoma. Circulating lymphoma (CL) cells can be seen at diagnosis in some FL patients, however, previous studies evaluating this have shown mixed results. Therefore, we sought to evaluate the impact of CL at diagnosis on outcomes in patients with newly diagnosed FL using data from a single center. Patients were divided into CL+ and CL- based on immunophenotyping via peripheral blood (PB) flow cytometry. CL was defined as detectable clonally restricted B-cells that matched the actual or expected B-cell immunophenotype of FL. The primary endpoint was progression-free survival (PFS) after first-line treatment and secondary endpoints included overall response rate (ORR), overall survival (OS), diagnosis to treatment interval (DTI), progression of disease within 2 years of diagnosis (POD24), and cumulative incidence of transformation between the two groups. Among the 541 patients with FL, 204 had PB flow cytometry performed at diagnosis, and after excluding patients not meeting the eligibility criteria, 147 cases remained with 24 (16%) CL+ at diagnosis. Patients in the CL+ group were younger (53 vs. 58 years, p = 0.02), had more extranodal involvement (83% vs. 44%, p < 0.01), follicular lymphoma international prognostic index 3-5 (55% vs. 31%, p = 0.01), and a higher proportion received first-line immunochemotherapy (75% vs. 43%, p = 0.01) compared to the CL-group. The median PFS was not significantly different between CL+ (6.27 years, 95% CI = 3.61-NR) and CL- (6.61 years, 95% CI = 5.10-9.82) cohorts regardless of the first-line treatment or level of absolute PB CL cells. There was no significant difference in ORR, median OS, DTI, POD24, and cumulative incidence of transformation between the two groups. In our study, we found that the presence of CL cells at diagnosis in FL in the contemporary era did not impact outcomes and survival.
滤泡性淋巴瘤（FL）是最常见的惰性 B 细胞非霍奇金淋巴瘤。在一些 FL 患者的诊断时，可以观察到循环淋巴瘤（CL）细胞，然而，以前的研究结果显示存在差异。因此，我们试图使用单个中心的数据评估新诊断的 FL 患者诊断时的 CL 对结局的影响。根据外周血（PB）流式细胞术的免疫表型，患者分为 CL+和 CL-。CL 被定义为可检测的克隆限制 B 细胞，与 FL 的实际或预期 B 细胞免疫表型相匹配。主要终点是一线治疗后的无进展生存期（PFS），次要终点包括总缓解率（ORR）、总生存期（OS）、诊断至治疗间隔（DTI）、诊断后 2 年内疾病进展（POD24），以及两组之间转化的累积发生率。在 541 例 FL 患者中，204 例行 PB 流式细胞术检查，排除不符合入选标准的患者后，147 例仍有 24 例（16%）诊断时 CL+。CL+组患者更年轻（53 岁 vs. 58 岁，p=0.02），结外受累更多（83% vs. 44%，p<0.01），滤泡性淋巴瘤国际预后指数 3-5 分（55% vs. 31%，p=0.01），一线免疫化疗比例更高（75% vs. 43%，p=0.01）。无论一线治疗或绝对 PB CL 细胞水平如何，CL+（6.27 年，95%CI=3.61-NR）和 CL-（6.61 年，95%CI=5.10-9.82）队列的中位 PFS 均无显著差异。两组间 ORR、中位 OS、DTI、POD24 和转化的累积发生率无显著差异。在我们的研究中，我们发现当代 FL 患者诊断时 CL 细胞的存在并不影响结局和生存。
