Real-World Analysis of First-Line Treatment Outcomes in Follicular Lymphoma

A recent retrospective analysis of real-world data published in Clinical Lymphoma, Myeloma, and Leukemia, evaluated treatment outcomes in patients with follicular lymphoma (FL) grades 1-3A receiving frontline bendamustine plus rituximab (BR) or rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP)-like regimens. This study leveraged data from the Flatiron Health electronic health record (EHR)-derived de-identified database, encompassing 2084 patients treated between 2011 and 2022.

The primary objective was to compare time to next treatment (TTNTD) between patients treated with BR vs RCHOP-like regimens. Results demonstrated a clinical improvement in TTNTD among patients treated with BR, with a median of 96 months versus 78 months for those treated with RCHOP-like regimens. Although this difference did not reach statistical significance (HR, 1.14; 95% CI, 0.981-1.327; P = .086), the findings align with previous prospective studies indicating improved progression free survival (PFS) with BR in patients with FL G1-2.

Among patients with FL G3A, TTNTD outcomes were comparable between the 2 regimens, with a median of 78 months for RCHOP-like and 73 months for BR (HR, 0.79; 95% CI, 0.542-1.142; P = .207). Overall survival (OS) in the FL G3A cohort showed a statistically significant advantage for those treated with RCHOP-like regimens (median 138 months) compared to BR (median 96 months, HR, 0.51; 95% CI, 0.313-0.834; P = .007), though this association did not maintain significance in multivariable analysis.

Maintenance rituximab (MR) was associated with improved TTNTD and OS in the overall cohort, irrespective of initial treatment regimen. However, in the FL G3A sub-analysis, MR was linked to improved TTNTD but not OS, suggesting potential nuances in the impact of MR based on disease grade and treatment response.

Despite a higher overall rate of transformation in the RCHOP-like cohort (7.4% vs. 4.7% for BR), the time to transformation was longer among patients receiving RCHOP-like regimens (26 vs. 8 months, P < .001). Transformation rates in the FL G3A cohort were similar to those observed in the FL G1-2 cohort.

This analysis underscores the clinical relevance of BR as a frontline treatment for FL and highlights the potential benefit of maintenance rituximab in prolonging TTNTD and OS. However, given the variability in outcomes among patients with FL G3A, further prospective studies are warranted to clarify optimal treatment strategies in this subset.

Reference

Baron K, Anto E, Esther J, et al. Comparison of real-world outcomes in patients with follicular lymphoma treated with BR versus RCHOP-like regimens. Clin Lymphoma Myeloma Leuk. Published online April 3, 2025. doi:10.1016/j.clml.2025.03.017