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

Overview

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

  • Batlevi, Connie L
  • Sha, Fushen
  • Alperovich, Anna
  • Ni, Ai
  • Smith, Katy
  • Ying, Zhitao
  • Gerecitano, John F
  • Hamlin, Paul A
  • Horwitz, Steve M
  • Joffe, Erel
  • Kumar, Anita
  • Matasar, Matthew J
  • Moskowitz, Alison J
  • Moskowitz, Craig H
  • Noy, Ariela
  • Owens, Colette
  • Palomba, Lia M
  • Straus, David
  • von Keudell, Gottfried
  • Zelenetz, Andrew D
  • Seshan, Venkatraman E
  • Luminari, Stefano
  • Marcheselli, Luigi
  • Federico, Massimo
  • Younes, Anas

publication date

  • January 8, 2020

Research

keywords

  • Antineoplastic Combined Chemotherapy Protocols
  • Lymphoma, Follicular
  • Neoplasm Staging
  • Positron-Emission Tomography

Identity

PubMed Central ID

  • PMC7331469

Scopus Document Identifier

  • 85077450213

Digital Object Identifier (DOI)

  • 10.1016/j.ejca.2019.12.006

PubMed ID

  • 31927165

Additional Document Info

volume

  • 126