While the expected survival of patients with FL almost reaches that of the normal population, the outcomes of patients who experience early progression within 24 months, that is, POD24 is dismal. Unlike the West, FL is less frequent in Asia as it accounts about 10% of non-Hodgkin’s lymphoma. To define outcomes and treatment patterns FL patients who experienced POD24 in Korea, we performed a multicenter, retrospective analysis.
The inclusion criteria were as follows, 1) Histologically confirmed diagnosis of FL grade 1, 2, and 3A; 2) Documented POD24. The primary endpoint was OS from the first diagnosis of FL.
Between 2007 to 2019, a total of 73 cases were eligible for analysis. Median age at diagnosis was 53 (range, 28 – 83). All patients were Asians. In terms of FLIPI-1 risk group, 14 (19.2%), 24 (32.9%), and 35 (47.9%) patients were categorized as low-, intermediate-, and high-risk group, respectively. Sixty-two patients (84.9%) had received rituximab as the induction treatment, and 11 patients (15.1%) had not. CVP was the most commonly used regimen (N=40), followed by CHOP (N = 26). Forty-four patients (60.3%) had received maintenance treatment with rituximab and 29 patients (39.7%) had not.
POD24 was documented after a median duration of 11.6 months. Rituximab wad administered in 19 patients, and platinum-based regimens (N = 23) were the most commonly used backbone treatment followed by bendamustine (N = 15) and fludarabine-based regimens (N = 12). PFS from the first progression was 23.7 months. The median OS was 128.9 mo, with the 5-year being 75.2%. OS did not significantly differ by the re-induction regimen, use of rituximab, or SCT.
When we compared these patients to our previous cohort in which 191 FL patients without POD24 were included, the 5-year survival rate was significantly inferior in the current cohort (75.2% vs. 95.7%, p < 0.001).
The 5-year OS rate of our patients with POD24 seems better than Western data, although there are many confounding factors including baseline FLIPI and the induction treatment. As expected, the 5-year OS rate of patient with POD24 was inferior to that of patients without POD24. To best salvage these patients, further studies are warranted to develop effective treatment.
The authors.
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All authors have declared no conflicts of interest.