Positron-emission tomography-based staging reduces the prognostic impact of early disease progression in patients with follicular lymphoma.

Abstract

BACKGROUND:

Previous studies reported that early progression of disease (POD) after initial therapy predicted poor overall survival (OS) in patients with follicular lymphoma (FL). Here, we investigated whether pre-treatment imaging modality had an impact on prognostic significance of POD.

METHODS:

In this retrospective study, we identified 1088 patients with grade I-IIIA FL; of whom, 238 patients with stage II-IV disease were initially treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), and 346 patients were treated with rituximab-based chemotherapy. Patients (N = 484) from the FOLL05 study served as an independent validation cohort. We risk-stratified patients based on pre-treatment radiographic imaging (positron-emission tomography [PET] versus computed tomography [CT]) and early POD status using event-defining and landmark analyses. A competing risk analysis evaluated the association between early POD and histologic transformation.

RESULTS:

In the discovery cohort, patients with POD within 24 months (PFS24) of initiating R-CHOP therapy had a 5-year OS of 57.6% for CT-staged patients compared with 70.6% for PET-staged patients. In the validation cohort, the 5-year OS for patients with early POD was 53.9% and 100% in CT- and PET-staged patients, respectively. The risk of histologic transformation in patients whose disease progressed within one year of initiating therapy was higher in CT-staged patients than in PET-staged patients (16.7% versus 6.3%, respectively), which was associated with a 9.7-fold higher risk of death.

CONCLUSION:

In FL, pre-treatment PET staging reduced the prognostic impact of early POD compared with CT staging. Patients with early POD and no histologic transformation have an extended OS with standard therapy.

• Authors: Connie L Batlevi, Fushen Sha, Anna Alperovich, Ai Ni, Katy Smith, Zhitao Ying, John F Gerecitano, Paul A Hamlin, Steve M Horwitz, Erel Joffe, Anita Kumar, Matthew J Matasar, Alison J Moskowitz, Craig H Moskowitz, Ariela Noy, Colette Owens, Lia M Palomba, David Straus, Gottfried von Keudell, Andrew D Zelenetz, Venkatraman E Seshan, Stefano Luminari, Luigi Marcheselli, Massimo Federico, Anas Younes
• Journal: European journal of cancer (Oxford, England : 1990) (Eur J Cancer) Vol. 126 Pg. 78-90 (02 2020) ISSN: 1879-0852 [Electronic] England
• PMID: 31927165 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2019 Elsevier Ltd. All rights reserved.

Chemical References

• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cyclophosphamide (administration & dosage)
• Disease Progression
• Doxorubicin (administration & dosage)
• Female
• Humans
• Kaplan-Meier Estimate
• Lymphoma, Follicular (diagnostic imaging, drug therapy, pathology)
• Male
• Middle Aged
• Neoplasm Staging (methods)
• Positron-Emission Tomography (methods)
• Prednisone (administration & dosage)
• Prognosis
• Retrospective Studies
• Rituximab (administration & dosage)
• Tomography, X-Ray Computed (methods)
• Vincristine (administration & dosage)
• Young Adult