Life expectancy of follicular lymphoma patients in complete response at 30 months is similar to that of the Spanish general population

Abstract

The use of immunochemotherapy has improved the outcome of follicular lymphoma (FL). Recently, complete response at 30 months (CR30) has been suggested as a surrogate for progression-free survival. This study aimed to analyse the life expectancy of FL patients according to their status at 30 months from the start of treatment in comparison with the sex and age-matched Spanish general population (relative survival; RS). The training series comprised 263 patients consecutively diagnosed with FL in a 10year period who needed therapy and were treated with rituximab-containing regimens. An independent cohort of 693 FL patients from the Grupo Español de Linfomas y Trasplante Aut ologo de M edula Osea (GELTAMO) group was used for validation. In the training cohort, 188 patients were in CR30, with a 10-year overall survival (OS) of 53% and 87% for non-CR30 and CR30 patients, respectively. Ten-year RS was 73% and 100%, showing no decrease in life expectancy for CR30 patients. Multivariate analysis indicated that the FL International Prognostic Index was the most important variable predicting OS in the CR30 group. The impact of CR30 status on RS was validated in the independent GELTAMO series. In conclusion, FL patients treated with immunochemotherapy who were in CR at 30 months showed similar survival to a sex-and age-matched Spanish general population.

The interval between frontline treatment and the second relapse (PFS2) predicts survival from the second relapse in follicular lymphoma patients

“…Since the advent of immunotherapy, despite a continuous pattern of relapses during follow-up, most FL patients have a prolonged survival, and a subset thereof have a life expectancy comparable to that of the general population. 9 It has been reported that the duration of response is progressively shorter with each line of treatment and that survival is consequently lower, with a median survival after the second relapse of 4.8 years, and a 5-years survival rate of 40%. 4 In the present study, we analyze the influence of the PFS2 on SFR2 in a series of 89 FL patients from two institutions, who were refractory to or relapsed after two lines of therapy, with the intention of capturing the clinical behavior of the patients from frontline treatment to the second relapse, as previously done in MM, where maintenance treatment is also customary.…”

“…7 Similarly, maintaining a complete response (CR) 30 months after induction therapy (CR30) has been identified as a surrogate of a longer OS, 8 with CR30 patients exhibiting a survival that is similar to that of the sex-and age-matched general population. 9 Considering that different treatments might affect the tumor's drug resistance profile, and pointing to the fact that progression of the disease on maintenance treatment has different consequences from progression off therapy, a guideline by the European Medicines Agency on the evaluation of anticancer drugs underscored the importance of designing clinical trials aimed at documenting benefits in terms of overall survival (OS). 10 In the case of diseases where OS is prolonged, and therefore, the demonstration of such benefits would require unpractically long observation periods, the Agency suggests the consideration of alternative endpoints, such as the progression-free survival (PFS) on next-line therapy (PFS2).…”

Immune microenvironment subtypes and association with tumor cell mutations and antigen expression in follicular lymphoma

“…Follicular lymphoma is an indolent disease, with some patients having equivalent overall survival to age-matched controls 15,16 . Decreasing the use of cytotoxic chemotherapy in the treatment of FL is therefore a priority.…”

Precision medicine in follicular lymphoma: Focus on predictive biomarkers

“…Except in specific settings, FL is incurable. However, the 10‐year overall survival (OS) is currently around 75% and life‐expectancy for most patients is similar to that of the general population 7,8,10‐13 . Therefore, improving outcomes will require carefully selecting patients who may benefit from specific interventions 14 .…”