IBCL-245: Clinicopathological profile and survival outcomes in follicular lymphoma: An institutional analysis from India

Abstract

Background: Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin lymphoma (NHL) in India. There is limited information available on FL from India. This study evaluates the clinicopathological profile, treatment outcomes, and prognostic factors in FL at a single tertiary-care center. Methods: The clinicopathological profile, treatment outcome, and prognostic factors for survival were assessed retrospectively in 107 FL patients treated at our tertiary center over 11 years (2012–2023). Results: There were 61 males and 46 females, with a median age of 53 years (range, 27–70). Common presenting symptoms were lymphadenopathy (60%) and fatigue (20%). The mean duration of symptoms before presentation was 7 months. The Ann Arbor stage distribution was: stage 1 (8%), 2 (10%), 3 (20%), and 4 (62%). Bone marrow involvement and bulky disease were observed in 38 (36%) and 29 (27%) patients, respectively, while extranodal involvement occurred in 65%. Based on the FLIPI-1, 19% were low risk, 24% intermediate risk, and 57% high risk. Histologically, 35 (32%) were grade 1, 51 (48%) grade 2, and 21 (20%) grade 3. Ninety-five (89%) received treatment at presentation. Regimens included BR (bendamustine and rituximab) in 64, RCHOP in 16, LR (lenalidomide and rituximab) in 6, and others in 9 patients. Rituximab maintenance therapy was given to 45 (42%), limited by financial constraints. The overall response rate (ORR) was 84%, with complete remission (CR) in 65%. During follow-up, 30 (28%) patients relapsed, and 10 transformed to diffuse large B-cell lymphoma (DLBCL). At a median follow-up of 60 months, median OS was not reached; median PFS was 114 months. Common toxicities included skin rash (13%) and febrile neutropenia (10%). Grade 3/4 toxicities occurred in 11%. Failure to attain CR (aHR, 0.45; 95% CI, 0.22–0.90; P = 0.024) was associated with poor PFS. Conclusion: FL in our population presents predominantly at advanced stages (3/4) with high FLIPI scores compared to Western data. BR is the most commonly used frontline regimen. Failure to attain CR is the most significant prognostic factor for poor outcomes.