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Background Follicular lymphoma (FL) prognosis is influenced by the composition of the tumour microenvironment. We tested an automated approach to quantitatively assess the phenotypic and spatial immune infiltrate diversity as a prognostic biomarker for FL patients. Methods Diagnostic biopsies were collected from 127 FL patients initially treated with rituximab-based therapy (52%), radiotherapy (28%), or active surveillance (20%). Tissue microarrays were constructed and stained using multiplex immunofluorescence (CD4, CD8, FOXP3, CD21, PD-1, CD68, and DAPI). Subsequently, sections underwent automated cell scoring and analysis of spatial interactions, defined as cells co-occurring within 30 μm. Shannon’s entropy, a metric describing species biodiversity in ecological habitats, was applied to quantify immune infiltrate diversity of cell types and spatial interactions. Immune infiltrate diversity indices were tested in multivariable Cox regression and Kaplan–Meier analysis for overall (OS) and progression-free survival (PFS). Results Increased diversity of cell types (HR = 0.19 95% CI 0.06–0.65, p = 0.008) and cell spatial interactions (HR = 0.39, 95% CI 0.20–0.75, p = 0.005) was associated with favourable OS, independent of the Follicular Lymphoma International Prognostic Index. In the rituximab-treated subset, the favourable trend between diversity and PFS did not reach statistical significance. Conclusion Multiplex immunofluorescence and Shannon’s entropy can objectively quantify immune infiltrate diversity and generate prognostic information in FL. This automated approach warrants validation in additional FL cohorts, and its applicability as a pre-treatment biomarker to identify high-risk patients should be further explored. The multiplex image dataset generated by this study is shared publicly to encourage further research on the FL microenvironment.

Plain language summaries (PLS) are accessible, short, peerreviewed summaries of scholarly journal articles written in nontechnical language.• The aim of PLS is to enable a broader audience of experts and non-experts to understand the original article.• Here, we outline the evidence base for the value and impact of PLS and how they can enable diversity, equity, inclusion and accessibility in scholarly publishing.• PLS can diversify readership and authorship, address information inequity, include typically under-represented stakeholders and provide an accessible route into scholarly literature.

Plain language summaries of peer-reviewed publications are intended for everyone engaging with medical research, such as patients, patient advocates, caregivers, healthcare professionals, and policymakers. These summaries encourage discussions around medical research and aid fully informed and shared decision-making. The broad range of stakeholders involved in pharmaceutical research now puts the pharmaceutical industry in a unique position to make the medical publishing model more open. We believe that the next step of openness is to create a more accessible and inclusive environment through the routine development of plain language summaries of peer-reviewed medical journal publications.There are many formats of plain language summaries, but plain text is the most discoverable through indexing in directories such as PubMed. Standardizing the minimum steps for the development and sharing of index-friendly plain language summaries can help promote the quality and credibility of these lay communications. The aim of a minimum standard is to build a universal foundation that encourages the accessibility, discoverability, and inclusivity of plain language summaries. This standard can then serve as a basis for summaries written for a more specific target audience or that include graphically and digitally enhanced formats that increase understanding and engagement, which we strongly encourage.

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