Follicular lymphoma: is there an optimal way to define risk?

Casulo, Carla

doi:10.1182/hematology.2021000264

Cited by 5 publications

(2 citation statements)

References 52 publications

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“…Further, R‐CHOP was more commonly used as 2nd line treatment for patients with POD24 compared with patients with later relapse, indicating a clinically more high‐risk disease. Predictive markers for risk of early progression/relapse and for identifying patients who will have long‐lasting remission to specific 1st line treatments in FL remain to be determined [ 6 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment sequencing and impact of number of treatment lines on survival in follicular lymphoma: A national population‐based study

Wästerlid,

Dietrich,

Oksanen

et al. 2024

eJHaem

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Follicular lymphoma (FL) is a clinically heterogeneous disease. The need for treatment, treatment sequencing, number of treatment lines, and its association with survival have not been described in a population‐based setting. We identified all patients diagnosed with FL in the Swedish Lymphoma register from 2007 to 2014, followed until 2020, with detailed data on progression/relapse, transformation, and 2nd and further lines of therapy. During a median follow‐up of 6.8 years, 1226 patients (69%) received 1st systemic treatment, 358 patients (20%) were managed with watch‐and‐wait (WaW) only, and 188 (10%) patients were treated with radiotherapy and did not require additional therapy during the study period. Among patients starting systemic treatment, 496 (40%), 224 (18%), and 88 (7%) received 2nd‐, 3rd‐, or 4th‐line therapy, respectively. The 10‐year cause‐specific cumulative incidence of transformation was 13%. Among patients managed with 1st line R‐single, R‐CHOP, or BR, 54%, 33%, and 29% required 2nd line, respectively. The cumulative probability of starting subsequent treatment within 2 years was 26% after 1st line and 35% after 2nd line treatment. Two‐year OS following 1st, 2nd, 3rd, and 4th line systemic treatment was 84%, 70%, 52%, and 36%, respectively, and remained similar when excluding transformations. We conclude that a substantial proportion of FL patients can be managed with WaW for a long period of time, while patients who require multiple treatment lines constitute a group with a large clinical unmet need. These results constitute valuable real‐world reference data for FL.

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Section: Discussionmentioning

confidence: 99%

Treatment sequencing and impact of number of treatment lines on survival in follicular lymphoma: A national population‐based study

Wästerlid,

Dietrich,

Oksanen

et al. 2024

eJHaem

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“…Even with this chemoimmunotherapy treatment, however, ~20% of patients either do not achieve complete remission or relapse within 24 months [ 6 , 7 ]. It is currently unclear how to prospectively identify those FLs at the highest risk of poor outcomes at diagnosis [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Relationship between BCL2 mutations and follicular lymphoma outcome in the chemoimmunotherapy era

et al. 2023

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How to identify follicular lymphoma (FL) patients with low disease burden but high risk for early progression is unclear. Building on a prior study demonstrating the early transformation of FLs with high variant allele frequency (VAF) BCL2 mutations at activation-induced cytidine deaminase (AICDA) sites, we examined 11 AICDA mutational targets, including BCL2, BCL6, PAX5, PIM1, RHOH, SOCS, and MYC, in 199 newly diagnosed grade 1 and 2 FLs. BCL2 mutations with VAF ≥20% occurred in 52% of cases. Among 97 FL patients who did not initially receive rituximab-containing therapy, nonsynonymous BCL2 mutations at VAF ≥20% were associated with increased transformation risk (HR 3.01, 95% CI 1.04–8.78, p = 0.043) and a trend toward shorter event-free survival (EFS, median 20 months with mutations versus 54 months without, p = 0.052). Other sequenced genes were less frequently mutated and did not increase the prognostic value of the panel. Across the entire population, nonsynonymous BCL2 mutations at VAF ≥20% were associated with decreased EFS (HR 1.55, 95% CI 1.02–2.35, p = 0.043 after correction for FLIPI and treatment) and decreased overall survival after median 14-year follow-up (HR 1.82, 95% CI 1.05–3.17, p = 0.034). Thus, high VAF nonsynonymous BCL2 mutations remain prognostic even in the chemoimmunotherapy era.

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Prognostic value of interim 18F-FDG PET/CT in adult follicular lymphoma treated with R-CHOP

et al. 2023

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Follicular lymphoma: is there an optimal way to define risk?

Cited by 5 publications

References 52 publications

Treatment sequencing and impact of number of treatment lines on survival in follicular lymphoma: A national population‐based study

Treatment sequencing and impact of number of treatment lines on survival in follicular lymphoma: A national population‐based study

Relationship between BCL2 mutations and follicular lymphoma outcome in the chemoimmunotherapy era

Prognostic value of interim 18F-FDG PET/CT in adult follicular lymphoma treated with R-CHOP

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