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4417 Time to Lymphoma Treatment within 24 Months in Watchful Waiting Follicular Lymphoma Defines Patients at High Risk for Progression: A Multicenter Analysis

Program: Oral and Poster Abstracts
Session: 623. Mantle Cell, Follicular, and Other Indolent B Cell Lymphomas: Clinical and Epidemiological: Poster III
Hematology Disease Topics & Pathways:
Research, non-Hodgkin lymphoma, Lymphomas, Translational Research, Clinical Research, indolent lymphoma, Diseases, patient-reported outcomes, Lymphoid Malignancies
Monday, December 11, 2023, 6:00 PM-8:00 PM

Fenghua Gao1*, Jing Liu1*, Jiesong Wang1*, Lihong Liu2*, Zhiming Li3*, Yuqin Song, MD4, Xudong Zhang5*, Hui Zhou6*, Xiuhua Sun7*, Wei Zhang8*, Bing Xu9*, Liping Su10*, Wen Shujuan11*, Rong Tao, MD, PhD12*, Ou Bai, MD/PhD13*, Qingyuan Zhang14*, Liqun Zou, MD, PhD15*, Xianhuo Wang1* and Huilai Zhang16*

1Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
2The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
3State Key Laboratory of Oncology in South China, Guangzhou, China
4Department of Lymphoma, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, BEIJING, China
5The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
6Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
7The Second Hospital of Dalian Medical University, Dalian, China
8Peking Union Medical College Hospital, Beijing, China
9The First Affiliated Hospital of Xiamen University and Institute of Hematology, Xiamen, China
10Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Taiyuan, Shanxi, CHN
11Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
12Fudan University Shanghai Cancer Center, Shanghai, China
13Department of Hematology, The First Hospital of Jilin University, Changchun, Jilin, China
14Harbin Medical University Cancer Hospital, Harbin, China
15West China Hospital of Sichuan University, Chengdu, China
16Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China

Purpose Follicular lymphoma (FL) is a clinically and molecularly heterogeneous disease, watch and wait (W&W) remains a management therapeutic option in patients with advanced-stage, low-tumor-burden and asymptomatic FL in the rituximab era. We continue to use Groupe d’Etudes des Lymphomes Folliculaires criteria for active disease to initiate therapy. We sought to understand whether time to lymphoma treatment (TLT) after diagnosis in patients who managed by W&W was a factor affecting survival outcomes in FL.

Patients and Methods Between 2008 and 2022, 411 FL patients from 16 institutions in China were managed by W&W strategy, and their TLT was retrospectively evaluated. Patients were further divided into training and validation Cohorts. Logistic regression was used to identify and incorporate independent predictors of early TLT into a model with variable scoring. Model performance was evaluated through the area under the receiver operating characteristic curve (AUC) and goodness-of-fit statistics.

Results After a median follow-up of 46 months, 35 percent of W&W patients experience TLT within 24 months (TLT24) after diagnosis, and the 5-year progression free survival (PFS) rate was significantly lower than that of patients who were treatment-free at 24 months (62.3% vs. 89.5%). In multivariable analysis, five clinical factors were identified as independent predictors of TLT24: stage III-IV, β2 microglobulin ≥ 3mg/L, lymphocyte-to-monocyte ratio<3.8, bone marrow involved and spleen enlargement. We calculated risk scores (TLT24PI) for each patient and defined three risk groups: low (0-1 points), intermediate (2 points), or high (3-5 points). Its AUC for TLT24 was 0.761 (95% CI, 0.698 - 0.823) in the development cohort and 0.761 (95% CI, 0.698 - 0.823) in the validation cohort. Risk groups were also associated with PFS (P<0.001).

Conclusion In patients with FL who initially managed by W&W, TLT within 24 months after diagnosis was associated with poor outcomes. We developed a multivariable model that incorporates clinical and laboratory factors to identify patients at high risk for TLT24, which may be useful to identify candidates for early interventional treatment.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH