Clinical features and outcomes of 1845 patients with follicular lymphoma: a real-world multicenter experience in China

Abstract

Clinical features and outcomes of FL patients in Chinese population are limited, thus promoting us to perform this analysis on a large cohort of 1845 patients with FL enrolled from nine medical centers nationwide in China. In this cohort, the median age of patients at diagnosis was 53 years, which was comparable to that reported previously for Chinese FL patients (49–51 years) but younger than that for Western FL patients (60–65 years). In contrast with Western patients, Chinese FL patients more likely involved extranodal sites but less frequently infiltrated bone marrow. Other clinical characteristics were comparable between two populations. In this study, 91% of patients were managed with chemotherapy, yielding 72% and 46% of overall-response rate and complete remission. After median 55-month follow-up, 5-year progressive-free and overall survival were 61% and 89%, respectively. Both were analogous to those reported in prior Chinese and Western studies. Consistent with published data, addition of rituximab into both induction (Ri) and maintenance (Rm) treatment led to the most favorable outcomes. Interestingly, Ri only had better outcomes than Rm only. Notably, 7% of patients experienced histologic transformation (HT) and correlated with poor survival. Of the transformed FL cases, 3% and 4% of HT events occurred prior to or post-treatment, respectively. Importantly, the latter displayed worse outcomes than the former. Altogether, this study provides real-world information of the largest cohort of FL patients so far in China, which might lay a foundation for clinical investigation of Chinese FL in future.

Clinical features and outcomes of patients with follicular lymphoma: A real-world study of 926 patients in China

“…A previous analysis by our center of a single-disease database of more than 3,000 lymphomas found that FL accounted for 24.13% of NHL, similar to that reported earlier for Western FL patients (22%-35%) ( 19) but slightly higher than that reported in Chinese cohorts (8.1%-23.5%) (20). The median age of onset was 54 years old in our cohorts, similar to that reported earlier for Chinese FL patients (49-53 years) (21,22) but much younger than that reported in Western cohorts (60-65 years) (7,23). Several studies from China showed the BMI (bone-marrow infiltration) rate of 15.2%-28% in patients with FL, similar to our results, significantly lower than that in Western patients (40%-70%) (5,13).…”

“…However, a study based on real-world data suggests that the value of rituximab maintenance in FL is limited and, in the absence of clear OS benefits, remains a controversial approach (31). Our study shows t ha t R maintenance after indu ction immunochemotherapy yielded the most favorable prognosis, which is consistent with the results of another real-world study in Chinese population (21). However, the study did not include bendamustine (B) in combination with rituximab or Obinutuzumab (G)-based chemotherapy, as B and G were not available in China until 2019 (32).…”

“…Approximately 90.9% of Chinese FL patients have ECOG ≤ 1, which is consistent with 91% previously reported in Western countries (24). Other clinical characteristics of FL patients in our cohort are comparable to those reported in FL patients in China and the Western cohort (19,(21)(22)(23)(24)(25). Some patients with FL showed related DLBCL components in lymph node biopsy at the time of diagnosis, and the biological and clinical significance remain unclear (10-12).…”

“…However, the study did not include bendamustine (B) in combination with rituximab or Obinutuzumab (G)-based chemotherapy, as B and G were not available in China until 2019 (32). Unlike approximately 20% of FL patients treated with observation in the cohorts of Western countries, only 7% of Chinese FL patients were administered with watch and wait (21). In the study, the ORR was 78.3%, and the 5-year PFS and OS of all patients were 57.8% and 88.7%, respectively.…”

Revealing the evolution of the tumor immune microenvironment in follicular lymphoma patients progressing within 24 months using single-cell imaging mass cytometry

“…Patients with follicular lymphoma (FL) who experience disease progression within 24 months (POD24) have inferior outcomes [ 1 , 2 ]. Current biological understanding of POD24 is mainly based on alterations acquired at the time of diagnosis of FL [ 3 ], including gene-mutation-based prognostic model POD24-PI [ 4 ] and TIME-based model BioFLIPI [ 5 ], but biological studies on POD24 stages are rare.…”