High FLIPI Research Articles

Follicular Lymphoma in Chile in the Adult Public Cancer Program: The Impact of Chemoimmunotherapy.

Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma (NHL) in the United States and Europe. However, data on FL from Latin America are scant. This study aims at better understand the clinical features, treatment patterns and outcomes of patients with FL in Chile. Of special interest was to evaluate POD24 as an adverse marker. We collected retrospective data from 722 patients 15 years or older diagnosed with FL and treated in 17 cancer centers in Chile between 2000 and 2019. Time to first treatment (TTFT), progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional-hazard regression models were fitted to investigate prognostic factor. The median age at diagnosis was 62 with a female predominance (63%); 73% of patients had advance stage disease and 68% had bone marrow involvement; 63% had intermediate or high FLIPI scores. The 1-year TTFT rate was 96%, and 30% of patients received chemoimmunotherapy. Adding rituximab to chemotherapy was associated with a higher complete response (69% vs. 60%; p < 0.001) and superior median OS (16 vs. 8 years; p < 0.001). Patients who experience POD24 had an inferior median OS (2.4 vs. 15 years). Our study shows a female predominance in patients with FL in Chile and confirms superior response and survival outcomes with adding rituximab to chemotherapy. Our study also confirms a poor OS in patients who experience POD24.

Real world outcomes in patients with follicular lymphoma treated with RCHOP vs BR.

e19038 Background: In patients (pts) with (w) follicular lymphoma (FL), BR is associated w improved progression free survival (PFS) compared to RCHOP. In clinical practice, RCHOP is frequently utilized in pts w grade (G) 1-2 FL w high SUVs or Ki-67% proliferation index, and G 3A FL due to concern for transformation. Using real world data, we compared treatment trends and outcomes in pts w FL treated w first line (1L) BR versus (vs) RCHOP. Methods: This study used the nationwide Flatiron Health electronic health record-derived de-identified database. Pts diagnosed w FL G 1-2 or 3A and treated between (bt) 2011-2022 w 1L BR or RCHOP were included. The primary objective was to compare time to next treatment or death (TTNT) bt the two cohorts. Overall survival (OS), and transformation and POD24 rate were also analyzed. Univariable and multivariable Cox regression models were used to evaluate the impact of various clinical factors (sex, ethnicity, ECOG PS, treatment center type, FL G, FLIPI, rituximab maintenance [mtn]) on TTNT and OS. Results: The study included 2,089 pts; 1,475 pts received BR (BR n=1387, BO [obinutuzumab] n=88,), and 614 pts received RCHOP (RCHOP n=459, OCHOP n=8, RCEOP [etoposide] n=4, RCHP n=1, RCEP n=1, RCVP n=137, OCVP n=4). Median age at diagnosis was 64. Most patients were male (53%), non-Hispanic (90%), had advanced stage disease (82%), ECOG PS 0 (57%), G 1-2 FL (85%), intermediate FLIPI (62%), were treated at a community practice (83%), and did not receive rituximab mtn (54%). At median follow up of 90 mos, median TTNT bt BR and RCHOP was 96 vs 78 mos (HR 1.146, 95% CI 0.986-1.332, p = 0.076). In a multivariable model, there was no significant association bt RCHOP and TTNT. Male sex, ECOG PS ≥ 2, and high FLIPI were associated w worse TTNT, and Rituximab mtn w improved TTNT. Among G 3A pts (n=304), more pts received RCHOP (57% vs 43%), and median TTNT bt BR and RCHOP was 73 vs 78 mos (HR 0.787, 95% CI 0.542-1.142, p=0.207). Median OS bt BR vs RCHOP was 126 vs 138 months (HR 0.878, 95% CI 0.718-1.075, p=0.207). Male sex, ECOG PS ≥ 2, high FLIPI, and treatment in community setting were associated w worse OS. Rituximab mtn was associated w improved OS. 115 (5.5%) pts had transformation to aggressive lymphoma. Transformation rates bt BR vs RCHOP were 4.83% vs 6.50% (p=0.2) among all G 1-2 pts (n=1785), and 3.85% vs 9.2% (p=0.069) among all G 3A pts (n=304). 310 (14.8%) pts had POD 24, including 13.3% of all pts treated with BR and 18.6% with RHCOP (p=0.002). Autologous stem cell transplant (ASCT) was used in 26 (8.4%) POD 24 pts, among whom there was no difference in ASCT rate bt BR vs RCHOP (8.2% vs 8.8%, p=0.9). Conclusions: This retrospective analysis of real-world data showed clinical improvement in TTNT w BR compared to RCHOP in all FL patients. Among patients w G 3A FL, there was no significant improvement in TTNT with RCHOP. Rituximab mtn was associated w improved OS. Rate of transformation was higher in G 3A patients treated with RCHOP. There was low rate of ASCT in POD24 pts.

Results from the follicular lymphoma (FL) outcomes in patients (pts) with relapsed/refractory (R/R) disease treated with systemic therapy in a real-world assessment (FLORA) study.

7076 Background: Odronextamab, an off-the-shelf CD20×CD3 bispecific antibody, has shown compelling efficacy (objective response rate [ORR] 80%, complete response [CR] rate 73%) and a generally manageable safety profile in pts with heavily pretreated R/R FL in the single-arm ELM-2 trial (NCT03888105; Villasboas, et al. ASH 2023). We evaluated outcomes in pts with R/R FL treated with currently available third-line or later (3L+) therapies in a real-world setting (FLORA; NCT05338879) to better evaluate the results from ELM-2 in the absence of a randomized control arm. This is the first real-world study in 3L+ FL that evaluated scans from 100% of the cohort. Methods: FLORA is a multicenter, retrospective, observational study, using electronic medical record or research databases, of pts with R/R FL who have received ≥2 prior lines of therapy (LoTs; including an anti-CD20 and an alkylator) and initiated 3L+ systemic therapy for FL between January 1, 2015 and December 31, 2020. After applying similar eligibility criteria to those in the ELM-2 trial, inverse-probability of treatment weighting (IPTW) was used to balance key prognostic characteristics between the trial and the real-world cohorts. Pts were followed from the start of qualifying LoT until death, end of study (December 31, 2021), or lost to follow-up, whichever occurred first. The primary endpoint was ORR assessed by independent central review (ICR). Secondary endpoints included ICR-assessed CR rate, disease control rate (DCR), progression-free survival (PFS), duration of response (DOR), and overall survival (OS) (see Bachy, et al. ASH 2022). Results: Pts in FLORA (N=100) generally had less severe disease than trial pts prior to IPTW. The most commonly used regimens were chemotherapy + anti-CD20, chemotherapy alone, and anti-CD20 + immunomodulatory agent. The IPTW cohort had a median age of 61 y, 59% POD24, 56% high FLIPI, 60% chemo-immuno refractory, 73% refractory to last LoT, and median (range) prior LoT: 3 (2–8). In the IPTW cohort, ORR was 52%, CR 31%, and DCR 62%. Median PFS (mPFS) was 11.5 mo, median OS was 26.1 mo, and median DOR (mDOR; responders in IPTW cohort: n=54) was 28.2 mo. Given the lack of regular scans in routine practice (37% of responders did not have any subsequent ICR assessment after CR/PR), sensitivity analysis that considered subsequent treatment as a progression event resulted in shorter mDOR (8.1 mo) and mPFS (7.2 mo). Conclusions: Pts in the FLORA study had markedly lower response rates than those in the R/R FL cohort of ELM-2. This study also showed that most pts still received an anti-CD20–based regimen in 3L+ in routine practice, highlighting the need for treatment options with different mechanisms of action that provide deep and durable responses and improve outcomes in this pt population. Clinical trial information: NCT05338879 .

Treatment of follicular lymphoma with a focus on radiotherapy

PurposeTo describe the overall treatment patterns of follicular lymphoma (FL) in a single tertiary institution, with a focus on the outcomes of radiotherapy treatment in this group of patients. Methods and materialsRetrospective analysis on 177 patients with FL registered from 1996 to 2011 and followed up to October 2017. Diagnosis was confirmed by histology and staging by clinical examination and imaging with positron emission tomography (PET) or computed tomography (CT) scan. Demographics, clinicopathological characteristics, treatment details and clinical outcomes were reviewed. ResultsFifty-five patients (31%) had early stage and 122 (69%) had advanced stage FL. Median follow-up was 7 years and 7.5 years for early and advanced FL respectively. For advanced stage, median overall survival (OS) was 12.9 years, 5-year and 10-year OS were 77% and 63%, and 5-year and 10-yr PFS were 57% and 40% respectively. In multivariable model, moderate FLIPI, palliative RT and anti-CD20 targeted therapy were significantly associated with OS when comparing with those with high FLIPI score, no RT and no anti-CD20 targeted therapy respectively. For early stage, median OS has not reached, 5-year and 10-year OS were 79% and 74% and 5-year and 10-year progression free survival (PFS) were 64% and 52% respectively. Stage 2 non-contiguous disease had significantly poorer survival than stage 1 patients in multivariable (HR 8.19, 95%CI 1.86 – 35.98) analysis. Overall, 49 of 177 patients (27.7%) had any form of radiotherapy as part of their treatment for FL. There were no in-field alone relapses seen in all cases treated with RT. 10% in early FL had G3-4 acute toxicities with RT whilst there was no G3-4 late toxicities. In advanced FL, there were no G3-4 acute toxicities with consolidation RT and 1 G3 with salvage RT. ConclusionFL has effective response rates to RT both in early and advanced FL. We demonstrated that: 1) stage 2 disease has poorer outcomes than stage 1 disease with stage 2 non-contiguous disease having the poorest outcomes, indicating the need for more aggressive treatment strategies for this group of patients; 2) there were no in-field alone relapses seen in all cases treated with RT; 3) overall, there is a general under-utilization of RT concurring with the literature. New prospective studies are therefore warranted to shed light on improving the utility of RT for patients with FL. With advances in molecular medicine, imaging and treatment approaches, there is potential for better stratification of different patient groups for more localized versus systemic treatments.

COMBINING BASELINE TOTAL METABOLIC TUMOR VOLUME AND BETA‐2‐MICROGLOBULIN LEVELS PREDICTS OUTCOMES IN HIGH BURDEN FOLLICULAR LYMPHOMA

Introduction: Follicular lymphoma (FL) usually presents an indolent course with repeated events of disease progression but treatment-free time intervals and patients’ survival are reduced at each relapse. Many prognostic scores exist but few are used in practice due to their complexity. Total metabolic tumor volume (TMTV) has demonstrated a strong prognostic value in FL and its routine use is increasing in academic centers. We aim to explore the predictive value of a simple prognostic score based on TMTV and beta-2-microglobulin (B2M) levels at baseline in high tumor burden FL to identify patients with the highest unmet medical need. Methods: In this monocentric retrospective analysis, we enrolled adult patients admitted to our hospital between 2006 and 2018 and fulfilling the following inclusion criteria: grade 1 to 3A FL with at least one high tumor burden criteria defined by the Groupe d'Etude des Lymphomes Folliculaires (GELF), available PET-CT images collected before first-line standard immunochemotherapy start and suitable for TMTV assessment. Baseline TMTV was determined using the 41% SUVmax threshold method. B2M levels were routinely measured at diagnosis. Primary endpoints were progression-free survival (PFS) and overall survival (OS) according to a score combining TMTV and B2M. Results: We included 126 FL patients in this analysis. Median age at time of treatment was 61 years (55; 57). Patients displayed advanced-stage disease (n = 112, 88.9%), intermediate (n = 51, 40.8%) or high (n = 62, 49.6%) FLIPI and intermediate (n = 40, 33.3%) or high (n = 31, 25.8%) PRIMA-PI scores. Median baseline SUVmax and TMTV were 12.1 (10; 17) and 606 mm3 (268;1219), respectively. Baseline B2M levels were measured for 125 (97%) patients and >3 mg/L in 30 (24%). Treatment regimens used were mostly R-CHOP like (n = 109, 86.5%) and R-lenalidomide (n = 9, 7.1%). 80 patients (63.5%) received a maintenance therapy during 24 months. We defined three risk categories : (i) Low risk (n = 45, 36%): TMTV ≤510 mm3 and B2M ≤3 mg/L; (ii) Intermediate risk (n = 57, 45.6%) : TMTV >510 mm3 or B2M >3 mg/L ; (iii) High risk (n = 23, 18.4%) : TMTV >510 mm3 and B2M >3 mg/L. With a median follow-up of 83 (52; 116) months, the 5-year PFS was 81.7% (95% CI: 71–94), 53.7% (95% CI: 41.8–69) and 38.6% (95% CI: 23–65) in the low, intermediate and high risk groups, respectively (p < 0.0001). Five-year OS was based on 14 deaths and estimated at 96.1% (95% CI: 91–100), 89.1% (95% CI: 81.2–97.7) and 73.7% (95% CI: 57.6–94.2) in the low, intermediate and high risk groups, respectively (p = 0.003). Keywords: aggressive B-cell non-Hodgkin lymphoma, diagnostic and prognostic biomarkers, PET-CT No conflicts of interests pertinent to the abstract.

Application of circulating tumour DNA in terms of prognosis prediction in Chinese follicular lymphoma patients.

Background: Follicular lymphoma (FL), an indolent non-Hodgkin lymphoma (NHL), is generally incurable. Favourable prognosis and durable remission are crucial for FL patients. The genetic mutation spectrum provides novel biomarkers for determining the prognosis of FL patients, but its detection is easily affected by the collection of tumour tissue biopsies. In this study, we aimed to describe the mutational landscape of FL using circulating tumour DNA (ctDNA) samples and to explore the relationship between mutations and prognostic indicators of clinical outcome in patients with newly diagnosed follicular lymphoma and the prognostic value of such mutations. Methods: A total of 28 patients with newly diagnosed FL were included in this study. A targeted NGS-based 59-gene panel was used to assess the ctDNA mutation profiles. Differences in clinical factors between patients carrying mutations and those without mutations were analysed. We also explored the relationship between gene mutation status, mean VAFs (variant allele frequencies) and clinical factors. The Kaplan‒Meier method was applied to analyse the overall survival (OS) and progression-free survival (PFS) of patients carrying mutations and those without mutations. Results: ctDNA mutations were detectable in 21 (75%) patients. The most commonly mutated genes were CREBBP (54%, 15/28), KMT2D (50%, 14/28), STAT6 (29%, 8/28), CARD11 (18%, 5/28), PCLO (14%, 4/28), EP300 (14%, 4/28), BCL2 (11%, 3/28), and TNFAIP3 (11%, 3/28), with a mutation frequency of >10%. Patients with detectable ctDNA mutation tended to present with advanced Ann Arbor stage (III-IV) (p = 0.009), high FLIPI risk (3-5) (p = 0.023) and severe lymph node involvement (No. of involved areas ≥5) (p = 0.02). In addition, we found that the mean VAF was significantly higher in patients with advanced Ann Arbor stage, high-risk FLIPI, elevated lactate dehydrogenase (LDH: 0-248U/L), advanced pathology grade, bone marrow involvement (BMI) and lymph node involvement. Additionally, KMT2D, EP300, and STAT6 mutations were associated with inferior PFS (p < 0.05). Conclusion: We described the ctDNA mutation landscapes in Chinese patients with newly diagnosed FL and found that ctDNA VAF means reflect tumour burden. Moreover, PFS was shorter in patients with KMT2D, EP300 and STAT6 mutations.

Body Composition in Patients with Follicular Lymphoma: Asso-Ciations between Changes in Radiomic Parameters in Patients Treated with R-CHOP-like and R-B Regimens: LyRa 01F

In patients with follicular lymphoma (FL), therapeutic advances have led to improved survival, and within this framework, it is important to identify treatment strategies offering a better quality of life. Using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), in patients treated with R-CHOP-like or R-Bendamustine regimens, we assessed changes in the bone mineral density (BMD), musculoskeletal index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at disease onset and at the end of therapy. We evaluated whether the high-steroid regimen could lead to more significant radiological changes than those induced by the steroid-free regimen and whether a low BMD at disease onset is an unfavorable prognostic index. Seventy-nine patients between 60 and 80 years old with a new diagnosis of FL were included in the study. Evaluation of Delta values (pre- and post-therapy mean values) in the two immunochemotherapy regimens showed differences in radiomic parameters within the two patient cohorts. The R-CHOP-like regimen was associated with a significant reduction in BMD, an increase in SAT and VAT, and a reduction in skeletal muscle density (SMD) and SMI. Moreover, patients with high FLIPI showed a BMD below the cut-off value. This study represents the first study demonstrating a prognostic correlation between FLIPI and low BMD.

Obinutuzumab-Based Immunochemotherapy Mitigates Early Progression Risk with a Substantial 2-Year Progression-Free Survival (PFS) in Patients with Previously Untreated Advanced Follicular Lymphoma and a FLIPI Score ≥2: An Interim Analysis of the Ambispective Urban Study

Introduction. The randomized GALLIUM trial showed that Obinutuzumab-based immunochemotherapy and maintenance achieves a longer progression-free survival (PFS) and a lower rate of early disease progression at 24 months (POD24) than rituximab-based therapy. These therapeutic benefits were not yet established in a real-life setting. We present early results of the first study worldwide designed to assess the effectiveness and safety of obinutuzumab plus chemotherapy in patients with previously untreated advanced follicular lymphoma (FL) and a FLIPI score ≥2. Methods. URBAN [NCT04034056] is a non-interventional, retrospective/prospective study involving 46 sites in Italy. The treatment plan included an obinutuzumab-chemotherapy (CHOP, CVP or Bendamustine) induction phase (6 months), followed by bimonthly obinutuzumab maintenance (24 months), and 1-year follow-up period after the last obinutuzumab administration. Participants should have received at least 2 cycles of obinutuzumab-chemotherapy induction before the enrolment (retrospective part). Treatment was delivered according to existing regulatory labels and local reimbursement requirements. The primary study endpoint was POD24 rate, i.e. progression of disease or death due to progression within 24 months from treatment initiation. Secondary endpoints were 2-year PFS and tumor response at end of induction (EOI). We report POD24 and 2-year PFS results for patients who started treatment 24 months before the clinical cut-off date (CCOD) of 31-Jan-2022 and the response at EOI for those who completed induction at CCOD. Patients with/without POD and PFS at 24 months were compared by gender, age, time from diagnosis to treatment start, FLIPI, ECOG performance status, and chemotherapy backbone. Results. At CCOD, 299 patients have been enrolled, 294 were at the EOI, and 178 and 189 patients were evaluable at 24 months for POD24 and PFS, respectively. Enrolled patients (n=299) had a median age of 62 years, with 158 (52.8%) females and 182 patients (59.9%) with a high (≥3) FLIPI score. The median time from diagnosis to treatment was 1.6 (0-71.5) months. Among the 294 patients who completed the induction, 263 were assessed for response at EOI. Response was assessed by PET-CT in 207 patients, by CT scan only in 40 and by other techniques in 16. In patients assessed with PET-CT, the overall response rate (ORR) was 97.6%, with complete response (CR) in 175 patients (84.5%), partial response (PR) in 27 (13.0%), stable disease (SD) in 2 (1.0%) and progressive disease (PD) in 2 (1.0%) (1 patient was not evaluable, N.E.); in patients assessed by CT scan only, ORR was 90%, with CR in 24 patients (60.0%), PR in 12 (30.0%), and PD in 3 (7.5%) (1 patient N.E.). The figure shows the Kaplan-Meier estimates for POD24. The results of POD24 by patients' characteristics, including the comparisons between patients with and without POD at 24 months, are summarized in the Table. It is important to note that due to the COVID-19 pandemic, 16.4% and 16.8% of patients respectively evaluable for POD24 and 2-year PFS had not received the planned obinutuzumab maintenance. At the time of CCOD, 21 (11.8%) patients had a POD24 event and 157 (88.2%) did not. The rate of patients with POD24 was significantly higher in males than in females (p=0.044), but no statistically significant differences were observed for other variables. Due to study timeline, all POD24 events occurred during the pandemic. Among the 189 patients evaluable for PFS, we observed a 2-year PFS of 83.1%. No statistically significant correlations have been identified between PFS events and clinical characteristics. No new or unexpected safety signals were reported. Most common any grade adverse events were neutropenia (22.1% of patients retrospectively and 26.1% of patients prospectively), thrombocytopenia (9.7% and 5.1%, respectively) and infections, including COVID-19 (8.4% and 27.1%, respectively). Conclusions. The results of this interim analysis showed that treatment of previously untreated FL patients with obinutuzumab and chemotherapy was associated with low POD24 rates, high rates of complete response and a substantial 2-year PFS. Despite the different patient populations and the likely impact of COVID-19 pandemic on the overall management of accrued patients, these real-life results are in line with those from the pivotal GALLIUM trial. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The prognostic nutritional index, an independent predictor of overall survival for newly diagnosed follicular lymphoma in China.

ObjectiveThe prognostic nutritional index (PNI) is an important prognostic factor for survival outcomes in various hematological malignancies. The current study focused on exploring the predictive value of the PNI in newly diagnosed follicular lymphoma (FL) in China.Materials and methodsThe clinical indicators and follow-up data of 176 patients who received chemotherapy or immunotherapy combined with chemotherapy with FL in our hospital from January 2016 to March 2022 were retrospectively analyzed. Cox proportional hazard model was used for univariate and multivariate analyses. Kaplan–Meier curves were used to calculate survival rates and draw survival curves. The log-rank test was applied to compare differences between groups.ResultsThe optimal cut-off value of PNI was 44.3. All patients were divided into a high PNI group (>44.3) and a low PNI group (≤44.3). The low PNI group had a low CR rate and a high risk of death, with a tendency toward POD24, and Both OS and PFS were worse than those in the high PNI group. PNI was able to predict OS and PFS in FL patients and was the only independent predictor of OS (P = 0.014 HR 5.024; 95%CI 1.388∼18.178) in multivariate analysis. PNI could re-stratify patients into groups of high FLIPI score, high FLIPI2 score, no POD24, and rituximab combined with chemotherapy. Moreover, integrating PNI into the FLIPI and FLIPI2 models improved the area under the curve (AUC) for more accurate survival prediction and prognosis.ConclusionPNI is a significant prognostic indicator for newly diagnosed FL in China that can early identify patients with poor prognosis and guide clinical treatment decisions.

Prospective evaluation of the prognostic value of circulating tumor DNA in patients with follicular lymphoma: A pilot study.

7569 Background: Follicular lymphoma (FL) is the most frequently occurring indolent non-Hodgkin lymphoma, with generally favorable outcomes but a variable clinical course. Around 20% of patients suffer progression of disease within 24 months (POD24) of chemoimmunotherapy. In this prospective study, we examined the prognostic value of circulating tumor DNA (ctDNA), before and during treatment, to predict response and POD24 in FL patients. Methods: We collected 110 plasma samples from 39 patients diagnosed with FL, prospectively enrolled in 8 Spanish hospitals and treated with Chemotherapy-Rituximab regimen from April 2017 to November 2020 with a median follow-up of 41 months (m). Samples were collected before treatment (basal), mid-treatment (3m), at the end of treatment (EOT) (6m) and relapse or follow-up. We performed targeted deep sequencing in cell-free DNA and paired genomic DNA from 30 formalin-fixed paraffin-embedded tumoral (FFPET) samples with the same gene panel. Results: Before treatment, ctDNA levels, measured as haploid genome equivalents per milliliter of plasma (hGE/mL), were detected in 17/30 patients. Basal ctDNA levels were higher in patients without complete response (CR) than in CR patients [18 vs 14 log2(hGE/mL); Mann-Whitney P = 0.007] and in patients with POD24 compared to those not-POD24 [18 vs 13 log2(hGE/mL); P = 0.005]. None of the 13 patients with zero basal ctDNA levels, experienced POD24. Patients with at least one mutation detected in basal ctDNA had an inferior 24-months PFS than patients without alterations (64 vs 100%, log-rank test P = 0.027). In addition, basal ctDNA levels were detected in one patient with low FLIPI, but partial response and POD24, and by contrast, no ctDNA was detected in another patient with CR and no progression event but high FLIPI. From the alterations detected in FFPET samples, 66% were also identified in basal ctDNA. No alterations were detected in basal ctDNA from 7 patients with CR and 3 patients with watch-and-wait strategy. Dynamic analysis showed that ctDNA levels decreased after treatment for every patient (3 mo), but the reduction at EOT was higher in patients achieving CR than in non-CR patients (12 vs 3 log-reduction) and in not-POD24 patients compared to those with POD24 (10 vs 8). Furthermore, patients with at least one mutation detected in ctDNA at EOT had a shorter 24-months PFS than those without alterations (50 vs 90%). The sensitivity to detect alterations in ctDNA at EOT was 94% in patients not achieving a CR and no mutation was detected in patients with CR. Conclusions: In a real-life, prospective-based population, we showed that pre-treatment and dynamic molecular response measured by ctDNA, could be useful to stratify patients and predict response to treatment and early relapse in FL patients.

Outcome of follicular lymphoma (FL) patients in maintenance with antiCD20 monoclonal antibodies (MoAb) in SARS-Cov2 era.

e19544 Background: Maintenance in FL patients (pts) improves progression free survival (PFS). SARS-Cov2 pandemic posed unique challenges for immunocompromised pts. Methods: This is an observational, multicenter, retrospective and prospective study. The aim is to evaluate the outcome of FL pts in maintenance with antiCD20-MoAb during SARS-Cov2 pandemic and how suspension of therapy affected lymphoma outcome and the risk of SARS-Cov2 infection and its morbidity and mortality. Results: 420 pts from 18 Italian Centers were included. Median age was 62 years old (range 27-91), 216 pts (51%) were male. Main clinical characteristics were: histological grade 1-2 vs 3A vs not valuable in 288 (69%) vs 109 (26%) vs 23 (5%), respectively; advanced stage in 361 (86%), high FLIPI score in 192 (46%) pts. All 420 pts were in antiCD20-MoAb maintenance at the time of SARS-Cov2 pandemic onset (March 2020): 333 (79%) were receiving maintenance after a first line, while 87 (21%) after a second line. 342 (81%) pts were receiving Rituximab, while 75 (18%) Obinutuzumab, 3 pts did not start the planned maintenance. Status of disease after induction was complete remission (CR) in 374 (89%), partial response (PR) in 41 (10%), progressive disease (PD) in 1, not evaluated in 4 patients, respectively. At the end of maintenance was CR in 265 (63%), PR in 19 (4%), stable disease (SD) in one and PD in 14 (3%) pts, maintenance is ongoing in 121 (29%) pts. Because of SARS-Cov2 pandemic maintenance treatment was temporary suspended in 122 (29%), definitively interrupted in123 (29%), not changed in 175 (42%). Median number of maintenance treatment administered at March 2020 was 2 (range 1-12), in pts who modified treatment median number of performed vs lost courses was 7 (range 0-11) vs 2 (range 1-12). Patients were divided into two groups according to the approach to maintenance during pandemic: pts who interrupted maintenance (temporary or definitively): groups A (245 (58%) cases) vs pts who did not modified maintenance: group B (175 (42%)). No differences in clinical characteristics, type of therapy and response were observed between the two groups. 29(7%) relapses were observed: 16 (7%) vs 13 (7%) in group A vs B. 70 (17%) pts experienced SARS-Cov2 positivity: 47 (19%) vs 23 (13%) in group A vs B. 53 (76%) pts had symptomatic COVID and 43 (61%) were hospitalized, with no differences between the two groups. Anti-SARS-Cov2 vaccine was administered in 349 patients, serology assessment was done in 46% of cases, showing 21 (13%) reactive vs 138 (87%) not reactive patients, with no differences between the two groups. 21 (30%) pts died because of COVID: 9 (19%) vs 12 (52%) in groups A vs B. Conclusions: Suspension of maintenance during SARS-Cov2 pandemic did not show a protection in terms of SARS-Cov2 positivity and morbidity. A trend in lower mortality is suggested. No differences in terms of relapse rate were observed, but longer follow up is needed.

Follicular Lymphoma in a Single Cancer Center and Validation of FLIPI, FLIPI2, PRIMA and POD24 in Non-Caucasian Patients from Peru

BackgroundFollicular lymphoma (FL) is the second most common non-Hodgkin lymphoma subtype seen in Caucasian countries. Recent data were published on FL from Latin America (LATAM), presenting information of 12 countries. However, this information is widely variable because of the diversity of the Latin population (Caucasian and mestizo individuals). Our aim was to evaluate the clinical features, treatment patterns outcomes of non-Caucasian patients with FL from a single cancer center. Our second aim was to validate FLIPI1, FLIPI2, PRIMA and POD-24 score in our cohort.Methods:This is a retrospective study, including all patients with a pathological diagnosis of FL at the National Institute of Neoplastic Diseases in Lima, Peru from 2010 to 2019. All cases were reviewed by specialized pathologists. Baseline clinical and pathological data were collected. Responses were assessed based on the Lugano criteria. Overall survival (OS) was estimated using the Kaplan-Meier method. Differences were compared with the log-rank test.ResultsFrom 2010 to 2019 4480 patients with B-cell lymphoma were diagnosed, 449 patients (10%) had grade 1 to 3A FL, 302 patients had the five variables for FLIPI, 242 for FLIPI2, 257 for the 2 variables for PRIMA prognostic index and 209 received systemic treatment and had enough information to evaluate POD24. The median age for the entire cohort was 59 years old (range 24-92), 49% of patients were ≥60 years, 46% were male, 22% had extranodal involvement, 34% had bulky disease (≥6 cm in diameter), 68% had stage III/IV disease, 32% had hemoglobin <12 g/dl, 8% had serum albumin <3 g/dl, 35% had elevated serum LDH, 33% had B2-microglobulin ≥3,5 mg/l, 22% had bone marrow involvement and 23% had lymph node sites >4. Low, intermediate and high FLIPI were seen in 39%, 27% and 34% of patients, respectively. Low, intermediate and high-risk FLIPI2 was seen in 23%, 54% and 23% of patients, respectively. Low, intermediate, and high PRIMA was seen in 53%, 12% and 35%, respectively. 209 patients received systemic treatment, 60% received CHOP ± rituximab (R), 13% CVP ± R, 15% CHOP, 11% CVP. Response data were available in 158 patients with complete response in 35%, partial response in 57% and no response in 8%, for an overall response rate of 92%. 19% of patient had disease progression within 24 months of first treatment initiation (POD24). For the entire cohort, the median follow-up time was 2.6 years (Interquartile range [IQR] 0.08-13.6), the median OS was not reached (IQR 4.2-not reached). 5y was OS 72% (95% CI 65-77). 5y OS for low, intermediate and high FLIPI were 90% (95% CI 81-94.5), 65% (95% CI 47.3-78.2) and 60.1% (95% CI 46.6-72.4), respectively (p<0.001; Figure a). 5y OS for low, intermediate and high FLIPI2 were 91.9% (95% CI 76.3-97.3), 75.4% (95% CI 63.8-83.7) and 52.9% (95% CI 35.5-67.6), respectively (p<0.001; Figure b). 5y OS for low, intermediate and high PRIMA were 80.5% (95% CI 70-87.6), 79.4% (95% CI 52-92), and 61% (95% CI 47-73), respectively (p=0.004; Figure c). Patients who had and did not have POD24 had median OS of 5.7 years (IQR 2-NR) and NR (IQR 5.1-NR), respectively (p<0.001). 5y OS for patients who had and did not have POD24 was 54.1 % (95% CI 31-63) and 75.2% (95% CI 66-82), respectively (p=0.01).Conclusion:FL has a lower incidence in non-Caucasian patients in Peru compared to those reported for Western countries or other LATAM Caucasian population. FL patients showed higher rates of high FLIPI and FLIPI2 than previously reported in the literature. Chemoimmunotherapy is the standard approach to FL patients, which is associated with high rates of overall response, but low rate of complete response. The OS rates are shorter than those reported in the previously LATAM cohort. Our study validates the prognostic value of FLIPI1, FLIPI2, PRIMA and POD24. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Validation of FLIPI1, FLIPI2, PRIMA and POD24 in Patients with Extranodal Follicular Lymphoma: A Cohort from Two Cancer Centers in Peru

BackgroundFollicular lymphoma (FL) is the second most common non-Hodgkin lymphoma subtype, being nodal involvement its main characteristic. However, data about Extranodal (EN) involvement is not reported in Latin American patients. Our aim was to evaluate the clinical features, treatment patterns outcomes of Peruvian patients with ENFL from two cancer centers and validate FLIPI1, FLIPI2, PRIMA and POD-24 prognostic index in our cohort.Methods:This is a retrospective study, including all patients with a pathological diagnosis of FL grade 1 to 3A treated at the National Institute of Neoplastic Diseases and Oncosalud, both in Lima, Peru from 2010 to 2019. All cases were reviewed by specialized pathologists. Baseline clinical and pathological data were collected. Responses were assessed based on the Lugano criteria. Overall survival (OS) was estimated using the Kaplan-Meier method. Differences were compared with the log-rank test.ResultsA total of 86 patients were evaluated. The median age was 61 years (30-91), 43% were male, 20% had bulky disease (≥6 cm in diameter), 51% had stage III/IV disease, 31% had hemoglobin <12 g/dl, 11% had serum albumin <3 g/dl, 25% had elevated serum LDH, 31% had B2-microglobulin ≥3,5 mg/l, 27% had bone marrow involvement and 19% had lymph node sites >4. The most frequent EN sites were gastrointestinal, bone marrow, cutaneous and breast with 22%, 21% and 9%, and 6%% respectively. Low, intermediate and high-risk FLIPI1 was seen in 56%, 23% and 21% of patients, respectively. Low, intermediate and high-risk FLIPI2 was seen in 28%, 58% and 14% of patients, respectively. Low, intermediate, and high PRIMA was seen in 57%, 10% and 33%, respectively. 55 patients (64%) received any treatment, 47% received CHOP ± rituximab (R), 16% CVP ± R, 22% radiotherapy alone, 9% CHOP, 15% other treatments. Response data were available in 44 patients with complete response in 45%, partial response in 43% and no response in 12%, for an overall response rate of 88%. From patients who received CHOP/CVP ± R, 13% patients had disease progression within 24 months of first treatment initiation (POD24). For the entire cohort (N=88) the median follow-up time was 2.1 years (interquartile range [IQR] 0.08-11.3), median overall survival was 8.25 years (IQR 4.4-not reached [NR]). 5y OS was71.7% (95% CI 55.3-82.9), figure 1. For the FLIPI group 5y OS for low, intermediate and high FLIPI were 86.9% (95% CI 64.7-95.6), 60.1% (95% CI 24.4-83.2) and 75.7% (95% CI 30.4-93.7), respectively (p=0.07; Figure 2). For the FLIPI2 group (N=58) 5y OS for low, intermediate and high FLIPI2 were 79.5% (95% CI 39.3-94.5), 77% (95% CI 55.3-89.2) and 86% (95% CI 33.4-97.8), respectively (p=0.86). For the PRIMA group (N=38) 5y OS for low, intermediate and high PRIMA was 86% (95%55.6-96.6), 100% (95% CI 100), and 80% (95% CI 42-95), respectively (p=0.80). Patients who had and did not have POD24 had median OS of NR (IQR 0.6-NR) and NR (IQR 2.69-NR), respectively. 5y OS for patients who had and did not have POD24 was 71.2 % (95% CI 48-85) and 75% (12.7-96), respectively (p<0.87).Conclusion:Peruvian patients with ENFL showed a higher rate of female patients. Gastrointestinal involvement was the most common primary site. The OS rates is similar to our nodal involvement cohort. Chemoimmunotherapy is the standard approach to FL patients, which is associated with high rates of overall response. In our study FLIPI, FLIPI2, PRIMA and POD24 were not predictors for OS, but larger cohorts and longer follow-up are needed to find more accurate predictors of survival in these patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Maintenance Rituximab or Observation after Frontline Treatment with Bendamustine-Rituximab (BR) for Follicular Lymphoma: A Real World Analysis Across 13 US Cancer Centers

Maintenance Rituximab or Observation after Frontline Treatment with Bendamustine-Rituximab (BR) for Follicular Lymphoma: A Real World Analysis Across 13 US Cancer Centers

Disease Factors and Not Comorbidity Drives Clinical Decisions in Elderly Patients with Follicular Lymphoma

▪Background: Elderly lymphoma patients may present complex disease- and patient-related features that influence choice of therapy and outcomes. Recent US Lymphocare data suggest elderly patients are most commonly treated with watchful waiting or single-agent rituximab, unique from younger subgroups, and found no difference in outcomes by treatment groups– but comorbidity was not studied. (Nabhan 2015) Comorbidity, as measured by the Charlson Comorbidity Index (CCI) with a cutoff of >1, has shown prognostic relevance in subsets of young FL patients and DLBCL, but has not been studied exclusively in elderly FL patients.We aimed to describe patient features, comorbidity use of PET staging, management choices, and the impact of “polypharmacy” on outcomes of FL patients aged 70 or older. We specifically sought to address whether the CCI influences management choice or outcomes in this increasingly common subgroup of patients.Methods: Patients with follicular lymphoma seen at the University of Washington/Seattle Cancer Care Alliance from 2008-2016 were identified through evaluation of ICD9/10 diagnosis codes. CCI was calculated, excluding lymphoma, for all patients who were divided into low CCI (CCI score of 0-1) or high CCI (≥2).Information on clinical presentation (grade/stage), CCI, number of medications (prescription, herbal, and vitamin), and management details were collected. “Polypharmacy” was defined as #meds above median. Kaplan-Meier estimates of time to treatment, progression-free survival (PFS), and overall survival (OS) generated and subject to univariate /multivariate analysis (JMP 11.0/SAS) based on CCI score, FLIPI, grade, use of PET staging, and polypharmacy.Results: 128 patients over age 70 were found, and 57 had adequate information and at least 3 months of follow-up from diagnosis; these were analyzed in detail.Patient characteristics are described in table 1. Median follow-up was 32 months. Most patients (34/57, 61%) had a CCI score of >1 and the median number of medications used was 8, including prescriptions, supplements, and vitamins. Of 57 patients, 26 (46%) underwent baseline PET imaging. 17 patients were observed initially, and the remaining 40 received either RT, R, or chemo/R.The median time from diagnosis to initiation of therapy was 5 months based on Kaplan-Meier analysis. Time to treatment was not affected by CCI>1, use of PET in staging, or most clinical features. Only FL grade 3, more than 4 nodal sites, and high risk FLIPI influenced time to initiation of treatment.Median PFS was over 5 years but continual relapses occurred with prolonged follow-up (Figure 1). PFS was unaffected by CCI>1, polypharmacy, or clinical features. Eight deaths occurred, though only 3 due to lymphoma. Analyzed against FLIPI, gender, and grade, only Hgb <12 predicted poorer OS (multivariate p=.007).ConclusionsIn this cohort of 57 elderly FL patients evaluated at a tertiary care center, relatively high rates of PFS and OS were observed. While follow-up for this dataset is only 32 months, and management decisions were non-standardized, neither CCI>1 nor presence of “polypharmacy” predicted time to initiation of therapy. On the other hand, high FLIPI score, grade 3, and high tumor burden /5 or more nodal sites predicted earlier time to treatment. Only presence of anemia was associated with worse OS. This data suggests that presently, disease-related factors remain a prime consideration for managing elderly FL patients in practice. Additionally, the CCI did not impact PFS or OS in elderly FL patients. Improved models for discriminating between comorbidities and tumor-related prognostic features for elderly FL patients are needed, to guide management of this growing population. [Display omitted] DisclosuresShadman:Celgene: Research Funding; Merck: Research Funding; Acerta Pharma: Research Funding; AbbVie: Other: advisory board; PLEXXIKON: Research Funding; Emergent: Research Funding; Pharmacyclics: Other: advisory board, Research Funding; Gilead: Research Funding; Genentech: Consultancy, Research Funding; TG Therapeutics: Research Funding. Shustov:Spectrum Pharmaceuticals: Consultancy, Research Funding; Celgene: Other: Publication assistance. Smith:Janssen: Research Funding; Portola Pharmaceuticals: Research Funding; Acerta: Research Funding; Genentech: Research Funding; Merck: Research Funding; Dohme Corp: Research Funding; Sharp: Research Funding; Pharmacyclics LLC, an AbbVie Company: Research Funding; Seattle Genetics: Research Funding.

Early Disease Progression Predicts Poorer Survival in Patients with Follicular Lymphoma (FL) in the GALLIUM Study

Early Disease Progression Predicts Poorer Survival in Patients with Follicular Lymphoma (FL) in the GALLIUM Study

Long Term Follow-up of the PRIMA Study: Half of Patients Receiving Rituximab Maintenance Remain Progression Free at 10 Years

Abstract In patients with follicular lymphoma and a high tumor burden, the intergroup PRIMA phase III study was designed to evaluate the potential benefit of 2 years of rituximab (R) maintenance after response to first line R-chemotherapy induction regimens (patients registered from 12/2004 until 4/2007). At a median follow up of 3 years (Lancet 2011) and 6 years (Blood 2013 122:509), a significant sustained improvement in progression free survival (PFS) was demonstrated in patients receiving R-maintenance; hazard ratios (HR) of 0.55 and 0.58, respectively. We report here the long term results of this study with 4 additional years of follow-up. Patients initially randomized between observation (n=513) and R-maintenance (n=505) were all followed for 7 years after randomization and thereafter until the 31/12/16 after having given an informed consent for this extended follow-up period consisting of a yearly physician visit (imaging procedures were according to local center practices after year 7). At data-base lock, the median follow-up of the entire patient cohort was 9 years (9.7 years for the 607 patients agreeing to extended follow-up). Median PFS for patients in the observation arm was reached at 4.06 years as compared to 10.49 years in the R-maintenance arm (Log-Rank, P = 60 years, male sex and high FLIPI category, but not randomization arm, were all associated with a higher risk of death in a Cox regression model. In summary, PRIMA study long term follow-up demonstrates that R-maintenance after induction immunochemotherapy provides a significant long term PFS benefit over observation. Despite the lack of OS benefit, it is noteworthy that more than half of the patients in the R arm remain free of disease progression and have not required new anti-lymphoma treatment beyond 10 years. With the prolonged life-expectancy of patients with follicular lymphoma, it is important to consider long term treatment-related toxicities and the risk of secondary malignancies related to repeated therapeutic interventions. Obtaining truly durable response with 1st line induction followed by R-maintenance remains an appealing treatment strategy for these patients. Disclosures Salles: Gilead: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Kite: Consultancy, Honoraria; MSD: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Servier: Consultancy, Honoraria; BMS: Consultancy; morphosys: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Research Funding. Feugier: Roche: Consultancy, Honoraria, Research Funding. Lopez-Guillermo: Celgene: Consultancy; Gilead: Consultancy; Janssen: Consultancy; Novartis: Consultancy; Roche: Consultancy, Other: Research grant. Belada: Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel grants , Research Funding, Speakers Bureau; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel grants , Speakers Bureau; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel grants , Speakers Bureau; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel grants, Speakers Bureau. Haioun: Amgen: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Sandoz: Consultancy, Honoraria; JANSSEN: Consultancy, Honoraria; GILEAD: Consultancy, Honoraria; PFIZER: Consultancy, Honoraria. Martin: Gilead: Consultancy; Janssen: Honoraria; Servier: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Roche: Consultancy, Honoraria. Delmer: Roche: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Janssen: Honoraria; Gilead: Consultancy, Honoraria. Simpson: Onyx: Research Funding; Celgene: Honoraria, Other: travel expenses; Pharmacyclics LLC, an AbbVie Company: Research Funding; Amgen: Research Funding; Roche: Honoraria. Leppa: Roche: Consultancy, Honoraria, Research Funding; Bayer: Research Funding; Janssen Cilag: Consultancy, Research Funding; Merck: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Research Funding. Soubeyran: CELGENE: Honoraria; TEVA: Honoraria; Roche: Research Funding; Pierre Fabre: Honoraria; SPECTRUM: Honoraria. Ribrag: Roche: Honoraria, Other: travel, accommodation, expenses; BMS: Consultancy, Honoraria; MSD: Consultancy, Honoraria; Infinity: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Nanostring: Consultancy, Honoraria; Epizyme: Consultancy, Honoraria; Pharmamar: Consultancy; Esai: Honoraria, Research Funding; ArgenX: Research Funding; Servier: Consultancy, Honoraria. Estell: Janssen: Membership on an entity's Board of Directors or advisory committees. Assemat: LYSARC: Employment. Zeuner: Roche: Employment. Coiffier: Celltrion, Inc: Consultancy, Honoraria. Tilly: Karyopharm: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Honoraria; Gilead: Honoraria; Immunogen: Honoraria; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Rituximab-Bendamustine in First Line Treatment of Patients with Follicular Lymphoma. Results of Prospective Multicenter Study

BACKGROUND. Follicular lymphoma (FL) is lymphoid tumor that occurs in 22% of all non-Hodgkin's lymphomas (NHL) in Russia with median age 65 years. FL has a high chemosensitivity and often recurs: five-year progression-free survival (PFS) with R-CHOP - 40%. Due to high risk of recurrence and median age of FL pts 65 years, we need to reduce toxicity. Rituximab-bendamustine (R-B) versus R-CHOP in common group (without dividing on cytological grade) increases PFS and has lower toxicity, so it is possible to apply it to patients with concomitant pathology.AIM. To study R-B efficiency in different cytological grade of FL.PATIENTS AND METHODS. We performed a prospective, multicenter, open-label trial in Russia since 1 of June 2013 till 1 of June 2017. The study included 65 patients with FL. Median age of patients was 59 years (from 30 to 78 years). Treatment was completed in 60 patients, so this group of patients was analyzed. Ratio between men and women was 1: 2. 29/60 of patients (48%) were older than 60 y.o. Patients received rituximab 375 mg / m2 on day 1 and bendamustine 90 mg / m2 on days 1 and 2 of a 4-week cycle (6 cycles).47/60 (78%) of pts were diagnosed with FL grade 1, 6/60 (10%) -2 grade, 7/60 (12%) - grade 3A. 55/60(91%) pts had nodular tumor growth type, 6/60(10%) - nodular-diffuse, 4/60 (7%) - diffuse. High risk according to FLIPI had 21/53 (39%) of patients with 1-2 cytologic grade of FL and 7/7 (100%) of pts with FL grade 3A.Extranodal lesions were revealed in 23/60 (38%) of cases: in 4/60 of cases - orbit, in 2/60 - parotid gland, in 3/60 - lungs, in 3/60 - intestines, in 1 / 60 - stomach, 2/60 - pancreas, 2/60 - uterus, 2/60 - skin, 1/60 - subcutaneous tissue, 3/60 - vertebrae, in 1/60 - latticed maze and nasal passages. In 20/23 of cases extranodal lesion was revealed in generalized stage of FL (including lymph nodes and bone marrow).Extranodal lesions were found in 35% of pts with FL grade 1-2, and 57% of pts with FL - grade 3A. Bulky also was observed more frequently in pts with FL grade 3 3/7 (43%) than in pts with FL grade 1-2 19/53 (36%).Results. Complete remission (CR) of disease was achieved in 34/60 (55%) pts, partial remission (PR) - 13/60 (21%) pts. Tumor progression observed in 11/60 (18%) cases, pts were withdrawn from the protocol. In 2/60 (6%) pts had stable disease after 4 courses of R-B. Consequently we performed high-dose chemotherapy with autologous stem cell transplantation for patients with stable disease.Frequency of CR and PR was higher in pts with FL grade 1-2 than in FL grade 3: 87% versus 28%. Progressive disease observed more frequently in FL grade 3A - 71% vs pts with FL grade 1-2 (13%). Median follow up was 42 (4-56) months. Bone marrow was sanitized in all cases of its lesion - 33/60 (55%).Conclusions. 3A cytological grade of FL is associated with high FLIPI score, presence of bulky and extranodal lesions. These parameters are predictive unfavorable factors of poor response to R-B induction therapy. The R-B allows performing stem cells mobilization and autoSCT that is actual in FL pts with bone marrow involvement. DisclosuresNo relevant conflicts of interest to declare.

The role of axicabtagene ciloleucel as a treatment option for patients with follicular/marginal zone lymphoma.

Chimeric antigen receptor (CAR) T-cell therapy with axicabtagene ciloleucel (axi-cel) continues to make its way in the treatment of B-cell lymphomas. Follicular lymphoma (FL) is the second most common non-Hodgkin’s lymphoma. While its prognosis is usually good, the disease is considered incurable and patients still relapse. High-risk subgroups such as high FLIPI score or early relapses (POD24) face poor outcomes. Current treatment options with phosphatidylinositol 3-kinase (Pi3K) inhibitors or other novel agents have clinical activity but short remission with cures remaining elusive. The ZUMA-5 study of axi-cel has shown high response rates with durable remissions with manageable toxicities, particularly in poor risk FL, replicating the outcomes in smaller and earlier studies. Long-term follow up will demonstrate the real impact of axi-cel in relapsed FL.

Interim Positron Emission Tomography (iPET) Assessed Using Deauville Score for Patients with Follicular Lymphoma Receiving First-Line Chemoimmunotherapy

Interim Positron Emission Tomography (iPET) Assessed Using Deauville Score for Patients with Follicular Lymphoma Receiving First-Line Chemoimmunotherapy