Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and Rituximab
Patients (pts) with asymptomatic low-burden follicular lymphoma (FL) are usually observed at diagnosis. Time to lymphoma treatment (TLT) initiation can however be very heterogeneous and risk factors of progression are poorly studied. Our study evaluated 201 pts with grade 1–3a low-tumor burden FL di...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-05-01
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| Series: | HemaSphere |
| Online Access: | http://journals.lww.com/10.1097/HS9.0000000000000861 |
| _version_ | 1797283796901429248 |
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| author | Cyrielle Rodier Lukshe Kanagaratnam David Morland Adélie Herbin Amandine Durand Adrien Chauchet Sylvain Choquet Philippe Colin René Olivier Casasnovas Eric Deconinck François Godard Alain Delmer Cédric Rossi Eric Durot |
| author_facet | Cyrielle Rodier Lukshe Kanagaratnam David Morland Adélie Herbin Amandine Durand Adrien Chauchet Sylvain Choquet Philippe Colin René Olivier Casasnovas Eric Deconinck François Godard Alain Delmer Cédric Rossi Eric Durot |
| author_sort | Cyrielle Rodier |
| collection | DOAJ |
| description | Patients (pts) with asymptomatic low-burden follicular lymphoma (FL) are usually observed at diagnosis. Time to lymphoma treatment (TLT) initiation can however be very heterogeneous and risk factors of progression are poorly studied. Our study evaluated 201 pts with grade 1–3a low-tumor burden FL diagnosed in four French centers between 2010 and 2020 and managed by a watch and wait strategy in real-life settings. After a median follow-up of 4.8 years, the median TLT was 4.2 years (95% confidence interval, 3.1-5.5). On multivariate analysis, elevated lactate dehydrogenase (hazard ratio [HR] = 2.2; P = 0.02), more than 4 nodal areas involved (HR = 1.7; P = 0.02) and more than 1 extranodal involvement (HR = 2.7; P = 0.01) were identified as independent predictors of TLT. The median TLT was 5.8 years for pts with no risk factor, 2.4 years for 1 risk factor, and 1.3 years for >1 risk factors (P < 0.01). In a subanalysis of 75 pts staged with positron emission tomography-computed tomography (PET-CT), total metabolic tumor volume (TMTV) ≥14 cm3 and standardized Dmax (reflecting tumor dissemination) >0.32 m−1 were also associated with shorter TLT (HR = 3.4; P = 0.004 and HR = 2.4; P = 0.007, respectively). In multivariate models combining PET-CT parameters and clinical variables, TMTV remained independent predictor of shorter TLT. These simple parameters could help to identify FL patients initially observed at higher risk of early progression. The role of PET-CT (extranodal sites and PET metrics) in low-burden FL appears promising and warrants further assessment in large cohorts. |
| first_indexed | 2024-03-07T17:35:58Z |
| format | Article |
| id | doaj.art-618ae591357644b0abed44960a2f7d15 |
| institution | Directory Open Access Journal |
| issn | 2572-9241 |
| language | English |
| last_indexed | 2024-03-07T17:35:58Z |
| publishDate | 2023-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | HemaSphere |
| spelling | doaj.art-618ae591357644b0abed44960a2f7d152024-03-02T16:45:08ZengWileyHemaSphere2572-92412023-05-0175e86110.1097/HS9.0000000000000861202305000-00004Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and RituximabCyrielle Rodier0Lukshe Kanagaratnam1David Morland2Adélie Herbin3Amandine Durand4Adrien Chauchet5Sylvain Choquet6Philippe Colin7René Olivier Casasnovas8Eric Deconinck9François Godard10Alain Delmer11Cédric Rossi12Eric Durot131 Department of Hematology, University Hospital of Reims, Hôpital Robert Debré, Reims, France3 Department of Research and Innovation, University Hospital of Reims, Hôpital Robert Debré, Reims, France4 Médecine Nucléaire, Institut Godinot, Laboratoire de Biophysique, UFR de Médecine, Université de Reims Champagne-Ardenne, and CReSTIC (Centre de Recherche en Sciences et Technologies de l’Information et de la Communication), EA 3804, Université de Reims Champagne-Ardenne, Reims, France5 Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France5 Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France6 Department of Hematology, University Hospital of Besançon, France7 Department of Hematology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France8 Department of Oncology, Clinique Courlancy, Reims, France5 Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France6 Department of Hematology, University Hospital of Besançon, France9 Médecine Nucléaire, Centre Georges-François Leclerc, Dijon, France1 Department of Hematology, University Hospital of Reims, Hôpital Robert Debré, Reims, France5 Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France1 Department of Hematology, University Hospital of Reims, Hôpital Robert Debré, Reims, FrancePatients (pts) with asymptomatic low-burden follicular lymphoma (FL) are usually observed at diagnosis. Time to lymphoma treatment (TLT) initiation can however be very heterogeneous and risk factors of progression are poorly studied. Our study evaluated 201 pts with grade 1–3a low-tumor burden FL diagnosed in four French centers between 2010 and 2020 and managed by a watch and wait strategy in real-life settings. After a median follow-up of 4.8 years, the median TLT was 4.2 years (95% confidence interval, 3.1-5.5). On multivariate analysis, elevated lactate dehydrogenase (hazard ratio [HR] = 2.2; P = 0.02), more than 4 nodal areas involved (HR = 1.7; P = 0.02) and more than 1 extranodal involvement (HR = 2.7; P = 0.01) were identified as independent predictors of TLT. The median TLT was 5.8 years for pts with no risk factor, 2.4 years for 1 risk factor, and 1.3 years for >1 risk factors (P < 0.01). In a subanalysis of 75 pts staged with positron emission tomography-computed tomography (PET-CT), total metabolic tumor volume (TMTV) ≥14 cm3 and standardized Dmax (reflecting tumor dissemination) >0.32 m−1 were also associated with shorter TLT (HR = 3.4; P = 0.004 and HR = 2.4; P = 0.007, respectively). In multivariate models combining PET-CT parameters and clinical variables, TMTV remained independent predictor of shorter TLT. These simple parameters could help to identify FL patients initially observed at higher risk of early progression. The role of PET-CT (extranodal sites and PET metrics) in low-burden FL appears promising and warrants further assessment in large cohorts.http://journals.lww.com/10.1097/HS9.0000000000000861 |
| spellingShingle | Cyrielle Rodier Lukshe Kanagaratnam David Morland Adélie Herbin Amandine Durand Adrien Chauchet Sylvain Choquet Philippe Colin René Olivier Casasnovas Eric Deconinck François Godard Alain Delmer Cédric Rossi Eric Durot Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and Rituximab HemaSphere |
| title | Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and Rituximab |
| title_full | Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and Rituximab |
| title_fullStr | Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and Rituximab |
| title_full_unstemmed | Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and Rituximab |
| title_short | Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and Rituximab |
| title_sort | risk factors of progression in low tumor burden follicular lymphoma initially managed by watch and wait in the era of pet and rituximab |
| url | http://journals.lww.com/10.1097/HS9.0000000000000861 |
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