Early progression in follicular lymphoma in the absence of histological transformation or high‐risk Follicular Lymphoma International Prognostic Index still has a favourable outcome

Abstract

Although follicular lymphoma (FL) patients relapsing within 24 months after firstline treatment (POD24) have a poor prognosis, some cases show notable survival after first relapse (SF1R). We aimed to characterize the POD24 FL population and to identify the main prognostic factors at progression. We selected 162 POD24 patients (80F; median age at first relapse 59 years) from a cohort of 1067 grades 1-3a FL-treated patients. The remaining 905 patients treated with first-line immunochemotherapy and diagnosed during the same period were used to compare outcomes in terms of survival. After a median follow-up of 11.0 years, 96 patients died (10y-SF1R of 40%). Age over 60 years (p < 0.001), high lactate dehydrogenase (LDH) (p < 0.001), haemoglobin (Hb) less than 120 g/L (p < 0.001), advanced stage (p < 0.001), high-risk Follicular Lymphoma International Prognostic Index (FLIPI) (p < 0.001), histological transformation (HT) (p < 0.001) and reaching less than complete response (CR) after salvage therapy (p < 0.001), predicted poor SF1R at relapse. In multivariate analysis only high-risk FLIPI and HT maintained prognostic significance for SF1R. POD24patients not transformed and with low/intermediate FLIPI at relapse behaved better than the remaining cases. POD24 patients showed an excess mortality of 38% compared to the general population. Although outcome of POD24 FL patients is poor, a considerable group of them (low/intermediate FLIPI and not transformed at first relapse) behave better.

Cost–effectiveness of obinutuzumab plus bendamustine in Chinese patients with relapse and refractory follicular lymphoma

“…For hematologic malignancies, the treatment effects and disease prognosis are mainly reflected by PFS and PPS. After reviewing the distribution of Follicular Lymphoma International Prognostic Index (FLIPI) scores of the patients in the clinical trials used as data sources in our model, we found that the patients who received R-mono and L-mono had a much lower proportion of high-risk FLIPI that could be correlated with poorer survival prognosis [ 15 ]. Thus, the health benefits associated with R-mono and L-mono could be overestimated in the cost–effectiveness analysis.…”