Leukemic Presentation Is Predictive Indicator for Relapse for Patients with Follicular Lymphoma Treated with Rituximab Containing Initial Therapy.

Abstract

4763 INTRODUCTION Peripheral blood involvement (leukemic presentation) is considered as a part of bone marrow involvement and detected about 18% of bone marrow (BM) involvement of follicular lymphoma (FL). It is not known whether leukemic presentation is an adverse prognostic factor in rituximab era. METHOD We retrospectively evaluate prognostic value of peripheral blood involvement in patients with follicular lymphoma received rituximab containing regimen as an initial therapy from October 2000 to January 2009. Leukemic presentation was defined by morphologic identification of an abnormal lymphoid population in the peripheral blood. RESULT Total 129 patients were treated with rituximab containing initial therapy. Bone marrow involvement was detected in 39 /108 (36.1%) patients and leukemic presentation was identified in 8 / 39 (20.5%) of patients with BM involvement. Leukemic presentation shows significant poorer progression free survival than BM involvement without peripheral blood involvement. (2yr PFS 23.4% vs 73.3% p=0.015) Multivariate analysis conducted by Cox proportional hazard analysis including five variables of FLIPI revealed Hb <12g/dl (HR 2.769 95% CI: 1.111-6.902 p=0.029) and leukemic presentation (HR 5.127 95% CI: 1.898-13.853 p=0.001) were significant independent adverse prognostic factor for PFS. CONCLUSION Leukemic presentation is a significant adverse prognostic factor of FL in rituximab era. Prognostic value of leukemic presentation should be validated in further study. Disclosures: No relevant conflicts of interest to declare.

Leukemic phase follicular lymphoma in a young adult

“… 8 Furthermore, patients with FL in leukemic phase may show suboptimal response to rituximab‐containing regimens. 13 Our younger patient had a high‐risk FLIPI score and presented with an aggressive form of follicular lymphoma but responded well to CHOP therapy. This outcome is different from what is typically observed in older patients, which raises the possibility that the prognostic impact of the leukemic phase of FL may differ between younger and older patients.…”

“…Studies have shown that high‐risk FLIPI and leukemic phase are associated with shorter progression‐free survival (PFS) in patients with follicular lymphoma 8 . Furthermore, patients with FL in leukemic phase may show suboptimal response to rituximab‐containing regimens 13 . Our younger patient had a high‐risk FLIPI score and presented with an aggressive form of follicular lymphoma but responded well to CHOP therapy.…”

Absolute B cell counts in blood predict long-term response in follicular lymphoma patients treated with rituximab without chemotherapy

“…Circulating lymphoma cells identified by morphology and/or flow cytometry and absolute neoplastic lymphocytosis (circulating lymphoma cells > 4 × 10 9 / L) have been investigated [26][27][28]. Studies in the rituximab era have shown that peripheral blood involvement has a negative impact on progression-free survival (PFS), time to progression, and TNT but no significant effect on OS [27][28][29][30]. In the study of Kodaira et al, leukemic presentation was defined by cytological identification of an abnormal lymphoid population in peripheral blood [29].…”

“…Studies in the rituximab era have shown that peripheral blood involvement has a negative impact on progression-free survival (PFS), time to progression, and TNT but no significant effect on OS [27][28][29][30]. In the study of Kodaira et al, leukemic presentation was defined by cytological identification of an abnormal lymphoid population in peripheral blood [29]. Maeshima et al required ≥ 1% typical small-cleaved cells in the blood smear or positive flowcytometry results and 11% consecutive FL patients thus showed peripheral blood involvement, with significantly shorter progression-free survival after rituximab-containing therapy, while OS did not differ between the groups [27].…”