Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance

Tobin, Joshua W.D.; Rule, Gabrielle; Colvin, Katherine; Calvente, Lourdes; Hodgson, David C.; Bell, Stephen; Dunduru, Chengetai; Gallo, James; Tsang, Erica S.; Tan, Xuan Ni; Wong, Jonathan; Pearce, Jessica; Campbell, Robert L.; Tneh, Shao Yang; Shorten, Sophie; Ng, Melissa; Cochrane, Tara; Tam, Constantine S.; Abro, Emad Uddin; Hawkes, Eliza A; Hodges, Georgina; Kansara, Roopesh; Talaulikar, Dipti; Gilbertson, Michael; Johnston, Anna; Savage, Kerry J.; Villa, Diego; Morris, Kirk; Ratnasingam, Sumi; Janowski, Wojt; Kridel, Robert; Cheah, Chan Yoon; MacManus, Michael; Matigian, Nicholas; Mollee, Peter; Gandhi, Maher K.; Hapgood, Greg

doi:10.1182/bloodadvances.2019000458

Cited by 21 publications

(22 citation statements)

References 33 publications

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“…There is also the ongoing debate regarding the optimal therapeutic sequencing approach, to both maximize durable response and quality of life. Finally, the most important question in FL is whether targeted therapy offers the possibility of high rates of cure not just in early but also advanced-stage disease [ 142 ]. That we can now plausibly ask such questions suggests that the future is bright for the management of FL.…”

Section: Discussionmentioning

confidence: 99%

Targeted Treatment of Follicular Lymphoma

Nath

Gandhi

2021

JPM

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Follicular lymphoma (FL) is the most common indolent B-cell lymphoma. Advanced stage disease is considered incurable and is characterized by a prolonged relapsing/remitting course. A significant minority have less favorable outcomes, particularly those with transformed or early progressive disease. Recent advances in our understanding of the unique genetic and immune biology of FL have led to increasingly potent and precise novel targeted agents, suggesting that a chemotherapy-future may one day be attainable. The current pipeline of new therapeutics is unprecedented. Particularly exciting is that many agents have non-overlapping modes of action, offering potential new combinatorial options and synergies. This review provides up-to-date clinical and mechanistic data on these new therapeutics. Ongoing dedicated attention to basic, translational and clinical research will provide further clarity as to when and how to best use these agents, to improve efficacy without eliciting unnecessary toxicity.

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Section: Discussionmentioning

confidence: 99%

Targeted Treatment of Follicular Lymphoma

Nath

Gandhi

2021

JPM

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“…The impact on cost-effectiveness of both short and long-term toxicities is often burdened by decreased quality of life, which is reflected in the disutility assigned to both the ‘failure’ health state and the disutility applied in the simulation during treatment periods. We used an average cost of commonly used systemic regimens (BR, R-CHOP, R-CVP and rituximab monotherapy) reflecting variable clinical practice and similar PFS among therapies from previous datasets (9, 14).…”

Section: Discussionmentioning

confidence: 99%

A cost-effectiveness analysis of front-line treatment strategies in early stage follicular lymphoma

Tobin

Crothers

Eric

et al. 2021

Preprint

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Recent data suggests the use of radiotherapy alone (RT) in Early-Stage Follicular Lymphoma is declining. Cost-effectiveness analysis of treatments has not been performed. We constructed a partitioning model (15-year horizon) to compare RT, combined-modality therapy (CMT) and immunochemotherapy with rituximab maintenance (ICT+RM) from a PET-staged cohort from the Australian Lymphoma Alliance. Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. AUD $75,000 was defined as the willingness-to-pay threshold (WTP). The direct healthcare costs were: RT $12,791, CMT $29,391 and ICT+RM $42,644. Compared with RT, CMT demonstrated minimal improvement in QALYs (+0.01) and an ICER well above the WTP threshold ($1,535,488). Compared with RT, ICT+RM demonstrated an improvement in QALYs (+0.41) with an ICER of $73,319. Modelling a 25% cost reduction with a rituximab biosimilar led to further ICER reductions with ICT+RM ($52,476). ICT+RM is cost-effective in early stage FL from the Australian taxpayer perspective.

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“…It raises the question of whether localized presentation is a matter of chance (i.e., incidental early identification of a process bound to disseminate with time) or represents an inherent biological property “directing” lymphoma to a distinct region. The latter hypothesis is supported by similarly low rates of progression in rigorously staged patients with localized follicular lymphoma (FL) treated with observation compared with radiotherapy (RT) [ 20 ]. Further, several studies have suggested that localized FL is often characterized by a unique genetic profile, lower rates of BCL2/IGH translocation and a higher dependence on local microenvironmental features [ 21 – 24 ].…”

Section: Localized Diseasementioning

confidence: 99%

“…However, a SEER analysis of 6568 patients with localized grade 1–2 FL found that upfront RT was associated with improved disease-specific survival (DSS) and overall survival (OS) compared to patients who did not receive RT (10 y and 20 y DSS 79% and 63% for RT vs. 66% and 51% for no RT) [ 45 ]. In contrast, several reports suggested similar OS for upfront RT compared with observation; most notably, a multicenter retrospective review of 256 patients with FL rigorously staged with PET and a BM biopsy and treated with RT ( n = 171) or watchful waiting (WW) ( n = 85) demonstrated no difference in the time to first chemotherapy (TTC) treatment (4-year TTC 75–80%) [ 20 , 37 , 46 , 47 ].…”

Section: Localized Diseasementioning

confidence: 99%

How we treat mature B-cell neoplasms (indolent B-cell lymphomas)

et al. 2021

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Mature B cell neoplasms, previously indolent non-Hodgkin lymphomas (iNHLs), are a heterogeneous group of malignancies sharing similar disease courses and treatment paradigms. Most patients with iNHL have an excellent prognosis, and in many, treatment can be deferred for years. However, some patients will have an accelerated course and may experience transformation into aggressive lymphomas. In this review, we focus on management concepts shared across iNHLs, as well as histology-specific strategies. We address open questions in the field, including the influence of genomics and molecular pathway alterations on treatment decisions. In addition, we review the management of uncommon clinical entities including nodular lymphocyte-predominant Hodgkin lymphoma, hairy cell leukemia, splenic lymphoma and primary lymphoma of extranodal sites. Finally, we include a perspective on novel targeted therapies, antibodies, antibody–drug conjugates, bispecific T cell engagers and chimeric antigen receptor T cell therapy.

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Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance

Abstract: Key Points Practices in early-stage FL are variable and include radiation alone, systemic therapy, CMT, or observation. Each practice resulted in similar excellent outcomes; randomized trials are required to determine the optimal treatment.

Cited by 21 publications

References 33 publications

Targeted Treatment of Follicular Lymphoma

Targeted Treatment of Follicular Lymphoma

A cost-effectiveness analysis of front-line treatment strategies in early stage follicular lymphoma

How we treat mature B-cell neoplasms (indolent B-cell lymphomas)

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