Early Progression of Advanced Follicular Lymphoma with Poor Outcomes Linked to New Combo

August 13, 2019

While many patients with follicular lymphoma did well with this new regimen, the majority of those who did have disease progression had transformed disease.

The majority of patients with advanced stage follicular lymphoma that progressed within 2 years (POD24) after receiving bendamustine/rituximab had transformed disease, according to a study published in Blood.

“Based on our findings, clinicians should be aware of the high risk of transformation in follicular lymphoma with POD24 after frontline bendamustine/rituximab, pursue biopsy confirmation wherever possible and consider when selecting next lines of therapy,” wrote researchers led by Ciara Freeman, of BC Cancer, Vancouver.

Freeman and colleagues conducted a retrospective study of 296 patients with advanced follicular lymphoma who underwent treatment with frontline bendamustine/rituximab, followed by maintenance rituximab.

According to the researchers, outcomes with this regimen were excellent. The 2-year event-free survival was 85% and 92% of patients were alive at 2 years. Ten percent of patients had evidence of disease transformation.

A small percentage (13%) of patients had disease progression within 24 months. The only risk factor associated with early progression was baseline LDH (P<.001). More than three-quarters (76%) of patients with early progression had transformed disease. Patients who had early progression had a 2-year overall survival of only 38%.

“Our population-based analysis demonstrates that in the absence of transformation or POD24, patients with advanced stage follicular lymphoma have excellent outcomes following frontline bendamustine/rituximab and maintenance rituximab,” researchers wrote. “The incidence of early progression with FL-only histology is uncommon following bendamustine/rituximab as it appears that the majority of POD24 patients in this population have transformed lymphoma.”

The researchers compared outcomes with a historical cohort of patients treated with the RCVP regimen. Both event-free survival (85% vs 76%; P=.001) and incidence of POD24 (13% vs 23%; P=.001) were improved with the bendamustine/rituximab regimen. There was no significant difference in overall survival though.

“Our findings reflect real-world outcomes following one of the most commonly used frontline therapies for FL and confirm those seen in recent clinical trials which identified a lower incidence of POD24 in patients treated with BR compared with RCVP (16.1% vs 26.9%), highlighted the poor outcomes for those with POD24 and identified that the baseline factor most strongly associated with risk of POD24 was serum LDH.”