Follicular lymphoma is one of the most common B-cell lymphoproliferative diseases. It is a particularly heterogeneous disease, therefore we must strive to provide more options in the choice of therapy. Research towards the so-called "personalized" treatment is very important, and this was also the aim of our scientific work at the Department of Hematology of the University of Debrecen.
Patients and study methods
Data were collected retrospectively from 143 patients treated from May 2009 to June 2020, and data from patients who underwent autologous stem cell transplantation between 2004 and 2021 were also collected, in a total of 49 cases. In our summary, we report on currently known and possible new prognostic factors, and possible new factors that can be used in autologous stem cell therapy as well. We tried to determine the factors affecting PFS and OS using multivariate analyses and ROC curves.
Staging PET/CT SUV max cut-off value of 9,85, (P = 0,0001, [HR]: 0,2535, 95% [CI]: 0, 1118–0, 4878) and Ly/Mo ratio of 3,41 (P = 0,0027, HR: 2,997, 95% CI: 1,463–6,142) significantly influenced patients' progression-free survival. Staging SUVmax >9.85 and Ly/Mo < cut-off values of 3,41 together identify a high-risk group. (P < 0,0001, HR: 0,0957, 95% CI: 0,03416–0,2685). We showed a similarly significant difference with the SUVmax cut-off value of 3,15 at interim PET/CT (P < 0,0001, HR: 0,1614, 95% CI: 0,06684–0,3897). Staging SUVmax above 9,85 and interim SUVmax >3,15 together also identify a high-risk group (P < 0,0001, HR: 0,1037, 95% CI: 0,03811–0,2824). In the latter case, the difference in PFS is also reflected in the difference in OS (P = 0,0506, HR: 0,1187, 95% CI: 0,01401–1,005). In the case of 49 patients who underwent ASCT, in terms of PFS, with values above 47 years and Ly/Mo ratio above the cut-off of 2,675 together define a group with a poor prognosis (P = 0,0019). Regarding OS, however, only age was found to be significant.
Biological prognostic factors such as Ly/Mo ratio may improve the prognostic power of PET/CT. The survival advantage observed in PFS is reflected in OS when the combination of staging and interim SUVmax is used. In the case of ASCT, in addition to age, the Ly/Mo ratio proved to be prognostic for PFS.