{"entity":{"id":"paper-casulo-pod24-follicular-lymphoma-jco-2015","kind":"paper","name":"Early relapse of follicular lymphoma after R-CHOP defines patients at high risk for death: an analysis from the National LymphoCare Study","aka":["Casulo 2015","POD24","Progression of disease within 24 months in follicular lymphoma"],"tldr":"One in five people whose follicular lymphoma came back within two years of first treatment had half the five-year survival of everyone else, which is why that two-year mark now changes the plan.","summary":"Follicular lymphoma is usually described as a disease people live with for decades. Casulo and colleagues showed that this is true of four fifths of patients and untrue of the rest, and gave the field a marker to tell them apart.\n\nThe National LymphoCare Study followed 588 patients with stage 2 to 4 follicular lymphoma treated with first-line R-CHOP. Progression within two years of diagnosis occurred in 110 patients (19 per cent); 420 (71 per cent) formed the reference group, 46 (8 per cent) were lost to follow-up and 12 (2 per cent) died without progression. Five-year overall survival was 50 per cent in the early-progression group against 90 per cent in the reference group. Adjusting for the Follicular Lymphoma International Prognostic Index left a hazard ratio of 6.44 (95 per cent confidence interval 4.33 to 9.58), and an independent validation set of 147 patients gave an adjusted hazard ratio of 19.8.\n\nWhat it changes in a clinic: early progression triggers a repeat biopsy, because transformation to diffuse large B-cell lymphoma is the commonest cause and is treated as an aggressive lymphoma; it moves the patient up the queue for treatment that does not depend on chemotherapy sensitivity, which now means CAR-T or a bispecific antibody; and it is a reason to look for a trial rather than repeat chemoimmunotherapy.","asOf":"2026-10-01","links":[{"label":"Journal of Clinical Oncology 2015","url":"https://doi.org/10.1200/JCO.2014.59.7534"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/26124482/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/26124482"}],"tags":["lymphoma-evidence"],"related":["paper-prima-final-rituximab-maintenance-follicular-jco-2019","paper-elara-tisagenlecleucel-follicular-nat-med-2022","lymphoma-roadmap"],"cancers":["follicular-lymphoma","non-hodgkin-lymphoma"],"sections":["diagnostics"],"technologies":[],"targets":[],"drugs":["rituximab","cyclophosphamide","doxorubicin","vincristine","prednisone"],"companies":[],"institutions":[],"pathways":[],"terms":["flipi","lymphoma-tx-pod24","r-chop"],"trials":["elara","zuma-5","mosun-len-mzl"],"people":[],"bottlenecks":["b-biomarker-validation","b-trial-design"],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2015,"doi":"10.1200/JCO.2014.59.7534","pmid":"26124482","authors":"Casulo C, Byrtek M, Dawson KL, et al.","paperType":"observational","findings":["Of 588 patients with stage 2 to 4 follicular lymphoma treated with first-line R-CHOP, 110 (19 per cent) progressed within two years of diagnosis.","Five-year overall survival was 50 per cent in the early-progression group against 90 per cent in the reference group.","The association persisted after adjustment for the Follicular Lymphoma International Prognostic Index, with a hazard ratio of 6.44 (95 per cent confidence interval 4.33 to 9.58).","An independent validation set of 147 patients gave an index-adjusted hazard ratio of 19.8."],"whatItMeans":"The single most used prognostic marker in follicular lymphoma, and the reason a relapse at 20 months is handled differently from one at 30 months. It is now a standard stratification factor and a standard eligibility criterion in trials of the disease.","caveats":["A description, not a diagnosis: the 24-month cut-off is a convention, and someone progressing at 25 months is not biologically different from one progressing at 23.","Derived in patients treated with R-CHOP; the proportion progressing early differs with other induction regimens.","An observational registry analysis, with the referral and recording limitations that implies.","It identifies a group retrospectively, after progression, so it cannot yet direct first-line treatment."],"changedPractice":true,"participants":588},"route":"/key-papers/paper-casulo-pod24-follicular-lymphoma-jco-2015/","neighbours":{"paper":[{"id":"paper-prima-final-rituximab-maintenance-follicular-jco-2019","kind":"paper","name":"Sustained progression-free survival benefit of rituximab maintenance in patients with follicular lymphoma: long-term results of the PRIMA study","route":"/key-papers/paper-prima-final-rituximab-maintenance-follicular-jco-2019/"},{"id":"paper-elara-tisagenlecleucel-follicular-nat-med-2022","kind":"paper","name":"Tisagenlecleucel in adult relapsed or refractory follicular lymphoma: the phase 2 ELARA trial","route":"/key-papers/paper-elara-tisagenlecleucel-follicular-nat-med-2022/"}],"roadmap":[{"id":"lymphoma-roadmap","kind":"roadmap","name":"Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting","route":"/roadmaps/lymphoma-roadmap/"}],"cancer":[{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"}],"drug":[{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"},{"id":"prednisone","kind":"drug","name":"Prednisone","route":"/drugs/prednisone/"},{"id":"rituximab","kind":"drug","name":"Rituximab","route":"/drugs/rituximab/"},{"id":"vincristine","kind":"drug","name":"Vincristine","route":"/drugs/vincristine/"}],"term":[{"id":"flipi","kind":"term","name":"FLIPI, FLIPI2 and POD24 (follicular lymphoma risk)","route":"/terms/flipi/"},{"id":"lymphoma-tx-pod24","kind":"term","name":"POD24: progression of follicular lymphoma within two years, and why it changes the plan","route":"/terms/lymphoma-tx-pod24/"},{"id":"r-chop","kind":"term","name":"R-CHOP (lymphoma chemoimmunotherapy)","route":"/terms/r-chop/"}],"trial":[{"id":"elara","kind":"trial","name":"ELARA","route":"/trials/elara/"},{"id":"mosun-len-mzl","kind":"trial","name":"Mosunetuzumab with lenalidomide in relapsed marginal zone lymphoma","route":"/trials/mosun-len-mzl/"},{"id":"zuma-5","kind":"trial","name":"ZUMA-5","route":"/trials/zuma-5/"}],"bottleneck":[{"id":"b-biomarker-validation","kind":"bottleneck","name":"Biomarkers are not validated or standardised","route":"/bottlenecks/b-biomarker-validation/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}