Tobin Joshua W D, Chikatamarla Venkata A, Matic Marko, Griffin Alison, Chowdhury Rakin, Salvaris Ross, Goh Amanda, Black Harrison, Tong Tsz Hung, Birks Callum, Jain Sanjiv, Goodall Elizabeth, Sirdesai Shreerang, Trevis Thomas, Steinepreis Elizabeth, Chen Yiyang, Li Li, Broadby Glenn, Gutta Naadir, Morris Kirk, Cochrane Tara, Trotman Judith, Talaulikar Dipti, Shortt Jake, Hodges Georgina, Hawkes Eliza A, Cheah Chan Y, Barraclough Allison, Manos Kate, Johnston Anna, Royle Jane, Mondello Patrizia, Ansell Stephen M, Hapgood Greg
Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
School of Medicine, The University of Queensland, Brisbane, Australia.
Blood Neoplasia. 2024 Oct 8;1(4):100044. doi: 10.1016/j.bneo.2024.100044. eCollection 2024 Dec.
Progression of follicular lymphoma (FL) or transformation (TFL) within 24 months of immunochemotherapy (ICT) represent high-risk defining events (HRDE) with poor overall survival (OS). We examined baseline clinical characteristics, imaging, and outcomes for patients experiencing HRDE with newly diagnosed FL requiring ICT. HRDE groups were: relapse or progression of FL within 24 months (FL24), early TFL (transformation <24 months of ICT), late TFL (transformation >24 months of ICT).433 patients were categorized as reference FL (Ref FL), n = 352 (no HRDE); FL24, n = 43; early TFL, n = 29; late TFL, n = 9. Chemotherapy included bendamustine (63%), CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone) (27%), or CVP (cyclophosphamide, vincristine, prednisone) (10%); 85% received rituximab/15% obinutuzumab and 48% received maintenance therapy. Compared with Ref FL group, OS from HRDE was inferior for FL24 (hazard ratio [HR], 3.93; 95% confidence interval [CI], 2.14-7.23), early TFL (HR, 8.16; 95% CI, 4.38-15.2), and late TFL (HR, 8.23; 95% CI, 3.18-21.25). OS from HRDE was inferior for early TFL compared with FL24 (HR, 2.08; 95% CI, 1.02-4.21). In multivariable analysis, performance status, lactate dehydrogenase, beta-2-microglobulin and grade 3A were associated with early TFL. Clinical characteristics did not differentiate early TFL from FL24. Maximum standardized uptake value was higher in early TFL but not FL24 compared to Ref FL. Early TFL and FL24 represent different HRDEs and are associated with inferior OS. Distinguishing early TFL from FL24 is important for biomarker development, management and to develop and interpret trials in this area of unmet need.
免疫化学疗法（ICT）24个月内滤泡性淋巴瘤（FL）进展或转化（TFL）是总体生存率（OS）较差的高风险定义事件（HRDE）。我们研究了需要ICT的新诊断FL患者发生HRDE的基线临床特征、影像学和结局。HRDE组包括：24个月内FL复发或进展（FL24）、早期TFL（ICT开始24个月内发生转化）、晚期TFL（ICT开始24个月后发生转化）。433例患者被分类为参照FL（Ref FL），n = 352例（无HRDE）；FL24，n = 43例；早期TFL，n = 29例；晚期TFL，n = 9例。化疗方案包括苯达莫司汀（63%）、CHOP（环磷酰胺、长春新碱、多柔比星、泼尼松）（27%）或CVP（环磷酰胺、长春新碱、泼尼松）（10%）；85%接受利妥昔单抗/15%接受奥妥珠单抗，48%接受维持治疗。与Ref FL组相比，FL24（风险比[HR]，3.93；95%置信区间[CI]，2.14 - 7.23）、早期TFL（HR，8.16；95% CI，4.38 - 1
