Progression-free survival after front line, second line and third line in patients with follicular lymphoma treated in clinical practice

• Published in: Acta oncologica Vol. 63; no. 1; pp. 267 - 272
• Main Authors: Rajamaki, Aino, Sorigue, Marc, Prusila, Roosa E I, Kuusisto, Milla E L, Kuitunen, Hanne, Jantunen, Esa, Mercadal, Santiago, Turpeenniemi-Hujanen, Taina, Sancho, Juan-Manuel, Sunela, Kaisa, Kuittinen, Outi
• Format: Journal Article
• Language: English
• Published: Sweden MJS Publishing on behalf of Acta Oncologica 06-05-2024; Medical Journals Sweden
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Female; follicular lymphoma; Humans; Lymphoma, Follicular - drug therapy; Lymphoma, Follicular - mortality; Lymphoma, Follicular - therapy; Male; Middle Aged; Original; Prognosis; Progression-Free Survival; Retrospective Studies; Rituximab - therapeutic use; survival; treatment; Young Adult
• ISSN: 0284-186X; 1651-226X; 1651-226X
• DOI: 10.2340/1651-226X.2024.24377

The modern-day therapeutic landscape for follicular lymphoma (FL) includes a number of highly effective therapies.
We set out to determine progression-free survival (PFS) after front line, second line, and third line of therapy on the basis of relevant biological characteristics and therapeutic choices. Patients (n = 743, 51% females, median 60 years old) diagnosed with grade 1-2 FL between 1997 and 2016 in nine institutions were included.
The median PFS1, PFS2, and PFS3 were 8.1 years (95% confidence interval [CI]: 7-9.3 years), 4.2 years (95% CI: 2.8-5.6 years) and 2.2 years (95% CI 1.7-2.8 years). We found longer PFS1 for (1) females, (2) younger age, (3) lower-risk follicular lymphoma international prognostic index (FLIPI), (4) standard intensity (over low intensity) regimens and (5) immunochemotherapy strategies and (6) maintenance rituximab. We found a shorter PFS2 for patients who received front-line immunochemotherapy. Older age at diagnosis correlated with a shorter PFS3. Intensity of front-line chemotherapy, maintenance, or POD24 status did not correlate with PFS2 or PFS3 in this dataset.
With current immunochemotherapy strategies, the natural course of FL is characterized by shorter-lasting remissions after each relapse. It will be interesting to see whether new therapies can alter this pattern.