The addition of rituximab to anthracycline-based chemotherapy demonstrates improved progression free survival (PFS) and overall survival (OS) in follicular lymphoma (FL), according to 35-year follow-up analysis presented at the 62nd Annual American Society of Hematology (ASH) Annual Meeting and Exposition.
This study was presented by Amulya Yellala, MBBS, University Of Nebraska Medical Center, Omaha.
“Although FL is often considered an incurable disease, overall survival has drastically improved with refinement and diagnostic techniques and also the addition of rituximab,” explained Dr Yellala.
This study examined outcomes of a large cohort of patients with FL treated over a 35-year period. PFS and OS were calculated from the time of diagnosis to progression or death and the time from diagnosis to death from any cause, respectively, and evaluated based on FLIPI score, tumor grade, and treatment regimen.
A total of 1037 patients from the Nebraska Lymphoma Study group were diagnosed with FL between 1983 and 2020. For FLIPI scores, 9.1% were characterized as high risk, 37.8% intermediate risk, and 33.6% low risk (19.5% unavailable). Among the histological grade, 23.1% were grade 1, 30.2% grade 2, 27.3% grade 3A, 2.5 % grade 3B, and 16.9 % composite lymphoma.
When analyzing treatment regimens, 24.5% of patients received anthracycline plus rituximab, 43.8% received an anthracycline based regimen without rituximab, 9.8% received rituximab without anthracycline and 10.6% received neither of these agents.
Across all groups, median PFS was 4.6 years and median OS was 12.1 years. Median OS was 16.1 years in patients who received rituximab compared to 9.89 years in those who did not.
Based on FLIPI scores, median PFS was 8.6 years, 3.6 years, and 2.1 years for low, intermediate, and high-risk groups, respectively. Additionally, OS was 15.1 years, 11.7 years, and 4.9 years, respectively. This suggests an association between FLIPI score and survival in FL.
Based on tumor grade, median PFS was 4.7 years, 4.2 years, 5.2 years, and 9.2 years in grade 1, grade 2, grade 3A, and grade 3B FL, respectively. Additionally, OS was 11.6 years, 14.3 years, 10.8 years, and 10.8 years, respectively.
Median PFS was found to be 10.6 years in patients treated with both anthracycline and rituximab compared with 5.3 years in patients treated with rituximab alone and 3.05 years in patients treated with anthracycline alone (P ≤.001). Median OS was 18.8 years in the combination regimen group compared with 11.3 years in rituximab alone group and 9 years in anthracycline based regimen group (P ≤.001).
“In conclusion, the addition of rituximab to standard anthracycline-based chemotherapy has resulted in significant improvements in the PFS and OS rates of FL,” Dr Yellala concluded.
“These results also support the prognostic value of FLIPI score in patients treated in the rituximab era,” she added.—Lisa Kuhns
Yellala A, Lyden ER, Nutsch H, et al. Thirty-Five Year Follow-up Analysis of Follicular Lymphoma Patients Treated through the Nebraska Lymphoma Study Group: Prognostic Factor Analysis and Outcomes. Presented at: the 62nd ASH Annual Meeting and Exposition; Dec 5-8, 2020. Abstract 2955.
