PB2015 FOLLICULAR LYMPHOMA: A CHOICE OF FIRST‐LINE THERAPY
Authors: Nesterova E. , Kovrigina A. , Gemdzhian E. , Plastinina L. , Babaeva F. , Obuchova T. , Magomedova A. , Gaponova T. , Kremeneckaya A. , Kravchenko S. 
Published: June 2019

Background:

Follicular lymphoma (FL) is a tumor of germinal center B‐cells submitted by centrocytes/centroblasts/large lymphoid cells in cases of transformation of the tumor in diffuse large B‐cell lymphoma (DLBCL). FL is characterized by recurrent and remitting current of the disease. Immunochemotherapy is the standard of patients (pts) therapy. The most frequently used regimens R‐CHOP and R‐B in the first line of treatment of pts with FL. Today is not defined criteria of choice for first‐line therapy of FL patients.

Aims:

To make a comparative analysis of clinical, laboratory, morphological parameters of pts with FL who received chemotherapy R‐B and R‐CHOP; to determine the criteria for the choice of induction therapy (R‐B or R‐CHOP).

Methods:

The study included 203 pts with FL during 2000 ‐ 2018. 77 pts were treated with R ‐ B, 126 pts ‐ R‐CHOP. Courses R‐B was carried out in five clinics in Moscow and four clinics of Russia, R‐CHOP – in National Research Center for Hematology, Moscow. Characteristics of pts are presented in table 1.

Results:

50/77 (61%) pts after R‐B therapy achieved complete remission (CR) of the disease, including 3 cases of early relapse. 15/77 (19%) pts achieved partial remission (PR) of the disease. In 13/77 (17%) cases, tumor progression was detected (in 7/13 patients 3A cytological type FL was diagnosed). In 1/77 (1%) pt after 4 courses of R‐B marked partial tumor response and he had autoSCT. Median follow‐up was 40 months.

Of 126 pts who received first‐line treatment R‐CHOP, 21/126 (17%) pts got autoSCT. 18/21 pts achieved CR (median follow‐up 81 months). In three cases, after complete remission of FL, relapses of FL occurred: 1 ‐ late relapse, 2 ‐ early relapses. In relapses of FL after autoSCT the most significant parameters were: a short anamnesis, an increase LDH, FLIPI 3‐5, bulky and extranodal foci. 14/126 pts after R‐CHOP therapy were treated with high‐dose therapy, but without autoSCT. 11/14 patients have CR of the disease (median follow‐up of 80 months). In 3/14 pts had early relapses. From 89/126 pts, who completed therapy only R‐CHOP and maintenance therapy R, 50/89 (56%) pts have developed recurrence of the disease. 39/89 (44%) pts have CR (the median follow‐up of 80 months). In 11/203 (5 %) patients there was a resistant course of the tumor.

5‐year OS in the R‐B group is higher than in the R‐CHOP group: 92% (Standard Error, ± 4%) vs. 87% (±3%). Frequency analysis shows that the number of deaths in different regimens differ statistically significantly: 4/62 (6.5%, R‐B) vs. 21/105 (20.0%, R‐CHOP), Fisher's exact test, p = 0.05; relative risk (R‐CHOP/R‐B): 2.8 (95% CI: 0.9‐7.7).

Summary/Conclusion:

In the analysis of 203 pts, independent predictors of OS and EFS in FL were determined. The high risk of adverse events associated with 3A cytological type of tumor. R‐B is more effective in FL of 1‐2 cytological type than 3A. In the presence of bulky and FLIPI 3‐5 relapse occurs three times more often after R‐CHOP (76%) than after high‐dose therapy. R‐B effectively sanitizes the bone marrow allows you to perform the successful mobilization of blood stem cells before autoSCT. Analysis of the results of immunohistochemistry in patients resistant to therapy showed that in all cases the tumor expressed CD20, in 8/11(73%) cases – CD10, in 7/11(64%) cases – BCL‐2, and in one case(1/11 (9%) ‐ there was a peripheral ”aureole” of T‐lymphocytes, framing tumor nodules, which have a deterrent effect.

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