Absolute B cell counts in blood predict long-term response in follicular lymphoma patients treated with rituximab withou
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ORIGINAL ARTICLE
Absolute B cell counts in blood predict long-term response in follicular lymphoma patients treated with rituximab without chemotherapy Henna-Riikka Junlén 1,2 & Sandra Lockmer 1,2 & Eva Kimby 1 & Björn Engelbrekt Wahlin 1,2 Received: 4 June 2020 / Accepted: 27 July 2020 / Published online: 17 August 2020 # The Author(s) 2020
Abstract Rituximab monotherapy is widely used for follicular lymphoma. However, there are no established predictors for response or response duration. We analyzed the long-term prognostic relevance of pre-treatment absolute blood counts of lymphocytes with subsets and monocytes in 265 follicular lymphoma patients, uniformly treated with rituximab without chemotherapy, in two Nordic Lymphoma Group trials. There were 265 previously untreated, stage II–IV follicular lymphoma patients with a median follow-up of over 10 years. Absolute B cell counts ≥ median (0.09 × 109/L) were an independent predictor for shorter time to next treatment or death (multivariable analysis P = 0.010). In univariate analysis, absolute monocyte counts ≥ median (0.5 × 109/L) did not correlate with time to next treatment or death, but with inferior overall survival (P = 0.034). Absolute T cell or T cell subset counts were not predictive for outcome. High absolute B cell counts, possibly reflecting circulating lymphoma cells, have an unfavorable impact on time to next treatment or death in patients treated with rituximab without chemotherapy. Keywords Follicular lymphoma . Rituximab . B cell . Monocyte . Lymphocyte
List of abbreviations B2M β2-microglobulin FL Follicular lymphoma FLIPI Follicular Lymphoma International Prognostic Index IFN Interferon-α2a LDH Lactate dehydrogenase NLG Nordic Lymphoma Group OS Overall survival PFS Progression-free survival UNL Upper normal limit TNT Time to next treatment or death WHO World Health Organization
* Björn Engelbrekt Wahlin [email protected] 1
Unit of Hematology, Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
2
Medicinsk enhet Hematologi, Tema Cancer, Karolinska University Hospital, Stockholm, Sweden
Introduction Follicular lymphoma (FL) is the most common indolent nonHodgkin lymphoma, and it is characterized by a highly variable clinical course [1]. FL consists of clonal centrocytes and centroblasts on whose numbers the World Health Organization (WHO) allocates FL to grades 1, 2, and 3A [1]. Standard first-line treatment is rituximab alone or in combination with chemotherapy. The Follicular Lymphoma International Prognostic Index (FLIPI) is the most common system for risk stratification of FL, also in the rituximab era [2, 3]. However, the FLIPI cannot guide the choice of therapy and better prognostic and predictive tools are needed. Non-malignant immune cells in the FL tumor microenvironment, supporting growth and survival of tumor cells and suppressing the antitumor immune response, also have prognostic relevance [4]. The host immune system is important for the clinical effect of therapy with the antiCD20 antibody rituximab, a
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