Follicular lymphoma in the modern era: survival, treatment outcomes, and identification of high-risk subgroups

Connie L. Batlevi, Fushen Sha, Anna Alperovich, Ai Ni, Katy Smith, Zhitao Ying, Jacob D. Soumerai, Philip C. Caron, Lorenzo Falchi, Audrey Hamilton, Paul A. Hamlin, Steven M. Horwitz, Erel Joffe, Anita Kumar, Matthew J. Matasar, Alison J. Moskowitz, Craig H. Moskowitz, Ariela Noy, Colette Owens, Lia M. PalombaDavid Straus, Gottfried von Keudell, Andrew D. Zelenetz, Venkatraman E. Seshan, Anas Younes

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Patients with follicular lymphoma (FL) frequently require multiple treatments during their disease course; however, survival based on lines of treatment remains poorly described in the post-rituximab era. Also, the Follicular Lymphoma International Prognostic Index (FLIPI) score was developed to predict survival at diagnosis, yet it remains unknown whether increase in FLIPI score following an initial observation period is associated with less-favorable outcomes. To address these knowledge gaps, we retrospectively studied 1088 patients with FL grade 1–3A managed between 1998 and 2009 at our institution. Median overall survival (OS) and progression-free survival (PFS) after first-line treatment were not reached and 4.73 years, respectively. Following successive lines of treatment, years of median OS and PFS were, respectively: after second-line, 11.7 and 1.5; third-line, 8.8 and 1.1; fourth-line, 5.3 and 0.9; fifth-line, 3.1 and 0.6; sixth-line, 1.9 and 0.5. In initially observed, subsequently treated patients, FLIPI score increase after observation was associated with inferior survival following first-line treatment. The reduced survival we observed after second-line and later therapy supports the development of new treatments for relapsed patients and benchmarks historical targets for clinical endpoints. This study also highlights the utility of changes in FLIPI score at diagnosis and after observation in identifying patients likely to have worse outcomes.

Original languageEnglish (US)
Article number74
JournalBlood cancer journal
Volume10
Issue number7
DOIs
StatePublished - Jul 1 2020

ASJC Scopus subject areas

  • Hematology
  • Oncology

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