IBCL-383 Follicular lymphoma: Impact of complete response on outcomes in FL: A tertiary care analysis

Abstract

Background: Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin lymphoma (NHL) in India. There are few studies about the clinicopathological features and survival outcomes of FL from India. Methods: This was a retrospective study in 101 patients with FL registered in our tertiary institute over a period of 12 years (2012-2023). The primary objective was to study the survival outcomes (overall survival [OS] and progression-free survival [PFS]) in patients with FL. Statistical analysis was done using the Software Statistical Package for the Social Sciences (SPSS) Version 29.0.20. Results: Out of 101 patients there were 58 males and 43 females, with median age of 52 years (range, 12-81 years). Ann Arbor stage distribution: stage I, 9%; stage II, 10%; stage III, 21%; and stage IV, 60%. Bone marrow involvement and bulky disease were seen in 34% and 16%, respectively. Extranodal involvement was seen in 60% patients. Follicular Lymphoma International Prognostic Index 1 (FLIPI) scores: low, 18%; intermediate, 26%; and high risk, 56% of cases. Eighty-eight patients (87%) received treatment at presentation or during follow-up. Chemotherapeutic regimens used: bendamustine and rituximab, n=67 (76%); lenalidomide and rituximab, n=8 (9%); and other regimens, n=13 (15%). Rituximab maintenance therapy was given in 49 cases (49%) only due to financial constraints. Eight cases during follow-up transformed to diffuse large B-cell lymphoma. Complete remission was achieved in 67% of patients and overall response rate was 85%. Receipt of the rituximab was the only factor associated with complete response (CR) and no other clinical and tumour characteristics were associated with treatment response. Median OS could not be reached and median PFS was 106 months, with a median follow-up of 60 months. Failure to attain CR (adjusted hazard ratio [aHR] 3.4; 95% CI, 1.1-10.5), anemia (aHR 3.8; 95% CI, 1.2-12.3), and raised LDH at baseline (aHR 3.1; 95% CI, 1.0-9.5) were associated with poor OS. Conclusion: This study highlights the various clinicopathological features and survival outcomes from FL in India. Patients with FL account for 10% of all lymphoma cases at our centre, with 20% anemia and 56% of patients were in high-risk FLIPI. Anemia and failure to attain CR were important prognostic variables for OS.