Early Progression of Advanced Follicular Lymphoma with Poor Outcomes Linked to New Combo

The majority of patients with advanced stage follicular lymphoma that progressed within 2 years (POD24) after receiving bendamustine/rituximab had transformed disease, according to a study published in Blood.

“Based on our findings, clinicians should be aware of the high risk of transformation in follicular lymphoma with POD24 after frontline bendamustine/rituximab, pursue biopsy confirmation wherever possible and consider when selecting next lines of therapy,” wrote researchers led by Ciara Freeman, of BC Cancer, Vancouver.

Freeman and colleagues conducted a retrospective study of 296 patients with advanced follicular lymphoma who underwent treatment with frontline bendamustine/rituximab, followed by maintenance rituximab.

According to the researchers, outcomes with this regimen were excellent. The 2-year event-free survival was 85% and 92% of patients were alive at 2 years. Ten percent of patients had evidence of disease transformation.

A small percentage (13%) of patients had disease progression within 24 months. The only risk factor associated with early progression was baseline LDH (P<.001). More than three-quarters (76%) of patients with early progression had transformed disease. Patients who had early progression had a 2-year overall survival of only 38%.

“Our population-based analysis demonstrates that in the absence of transformation or POD24, patients with advanced stage follicular lymphoma have excellent outcomes following frontline bendamustine/rituximab and maintenance rituximab,” researchers wrote. “The incidence of early progression with FL-only histology is uncommon following bendamustine/rituximab as it appears that the majority of POD24 patients in this population have transformed lymphoma.”

The researchers compared outcomes with a historical cohort of patients treated with the RCVP regimen. Both event-free survival (85% vs 76%; P=.001) and incidence of POD24 (13% vs 23%; P=.001) were improved with the bendamustine/rituximab regimen. There was no significant difference in overall survival though.

“Our findings reflect real-world outcomes following one of the most commonly used frontline therapies for FL and confirm those seen in recent clinical trials which identified a lower incidence of POD24 in patients treated with BR compared with RCVP (16.1% vs 26.9%), highlighted the poor outcomes for those with POD24 and identified that the baseline factor most strongly associated with risk of POD24 was serum LDH.”