IBCL-293: Outcomes of follicular lymphoma patients treated with a uniform protocol: A single-institution analysis

Abstract

Background: Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin lymphoma (NHL) in India. Bendamustine-rituximab (BR) is a widely adopted regimen for treatment-naive FL. However, limited data exist from Indian cohorts regarding survival outcomes with this approach. This study evaluates the clinical characteristics, treatment outcomes, and prognostic factors of FL patients treated with the BR regimen at a single tertiary care center. Methods: This retrospective study included 107 patients diagnosed with FL and registered at our institution between 2012 and 2023. Among these, 64 patients were uniformly treated with 6 cycles of the BR regimen, with or without rituximab maintenance therapy. Results: Of the 64 patients, 37 were male and 27 were female, with a median age of 52 years (range, 27–70). The Ann Arbor stage distribution was as follows: stage 1 (2%), stage 2 (6%), stage 3 (20%), and stage 4 (72%). Bone marrow involvement and bulky disease were observed in 41% and 33% of patients, respectively, while extra nodal involvement occurred in 77%. Based on the Follicular Lymphoma International Prognostic Index (FLIPI-1), 11% were low risk, 23% intermediate risk, and 66% high risk. Rituximab maintenance therapy was administered to 32 patients (50%), with financial constraints being a key limiting factor. The overall response rate (ORR) was 89%, and complete remission (CR) was achieved in 75% of patients. During follow-up, two patients experienced transformation to diffuse large B-cell lymphoma (DLBCL). At a median follow-up of 60 months, the median overall survival (OS) was not reached. PFS rates were 87.3% at 12 months (95% CI, 79.5%–95.9%) and 67.7% at 60 months (95% CI, 55.6%–82.3%), demonstrating sustained long-term efficacy of the BR regimen. The most common toxicities included skin rash (13%) and febrile neutropenia (10%). All-grade toxicities were observed in 34% of patients. Maintenance rituximab was significantly associated with better progression-free survival (PFS) (adjusted hazard ratio [aHR], 0.23; 95% CI, 0.08–0.64), while no other clinical or tumor characteristics correlated with survival outcomes. Conclusion: This study highlights the favorable efficacy and manageable toxicity profile of the BR regimen in treatment-naive FL patients. Rituximab maintenance therapy after induction immunochemotherapy improves PFS.