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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.
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.
The 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.
What 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.
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.
Shares R-CHOP (lymphoma chemoimmunotherapy), Prednisone, Vincristine, Rituximab and the tag lymphoma-evidence.
Shares R-CHOP (lymphoma chemoimmunotherapy), Prednisone, Vincristine, Rituximab and the tag lymphoma-evidence.
Shares Sustained progression-free survival benefit of rituximab maintenance in patients with follicular lymphoma: long-term results of the PRIMA study, FLIPI, FLIPI2 and POD24 (follicular lymphoma risk), Prednisone, Vincristine and the tag lymphoma-evidence.
Shares R-CHOP (lymphoma chemoimmunotherapy), Prednisone, Vincristine, Rituximab and the tag lymphoma-evidence.
Shares R-CHOP (lymphoma chemoimmunotherapy), Prednisone, Vincristine, Rituximab and the tag lymphoma-evidence.
Shares R-CHOP (lymphoma chemoimmunotherapy), Prednisone, Vincristine, Rituximab and the tag lymphoma-evidence.
Shares R-CHOP (lymphoma chemoimmunotherapy), Prednisone, Vincristine, Rituximab and the tag lymphoma-evidence.
Shares Prednisone, Vincristine, Rituximab, 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 and the tag lymphoma-evidence.