BACKGROUND Previous studies reported that early progression of disease (POD) after initial therapy predicted poor overall survival (OS) in patients with follicular lymphoma (FL). Here, we investigated whether pre-treatment imaging modality had an impact on prognostic significance of POD. METHODS In this retrospective study, we identified 1088 patients with grade I-IIIA FL; of whom, 238 patients with stage II-IV disease were initially treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), and 346 patients were treated with rituximab-based chemotherapy. Patients (N = 484) from the FOLL05 study served as an independent validation cohort. We risk-stratified patients based on pre-treatment radiographic imaging (positron-emission tomography [PET] versus computed tomography [CT]) and early POD status using event-defining and landmark analyses. A competing risk analysis evaluated the association between early POD and histologic transformation. RESULTS In the discovery cohort, patients with POD within 24 months (PFS24) of initiating R-CHOP therapy had a 5-year OS of 57.6% for CT-staged patients compared with 70.6% for PET-staged patients. In the validation cohort, the 5-year OS for patients with early POD was 53.9% and 100% in CT- and PET-staged patients, respectively. The risk of histologic transformation in patients whose disease progressed within one year of initiating therapy was higher in CT-staged patients than in PET-staged patients (16.7% versus 6.3%, respectively), which was associated with a 9.7-fold higher risk of death. CONCLUSION In FL, pre-treatment PET staging reduced the prognostic impact of early POD compared with CT staging. Patients with early POD and no histologic transformation have an extended OS with standard therapy.

中文翻译：

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基于正电子发射断层扫描的分期减少了滤泡性淋巴瘤患者早期疾病进展的预后影响。

背景先前的研究报道，初始治疗后疾病的早期进展（POD）预示着滤泡性淋巴瘤（FL）患者总生存期（OS）较差。在这里，我们研究了治疗前成像方式是否对 POD 的预后意义有影响。方法 在这项回顾性研究中，我们确定了 1088 名 I-IIIA 级 FL 患者；其中，238名II-IV期疾病患者最初接受了利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗，346名患者接受了以利妥昔单抗为基础的化疗。FOLL05 研究中的患者 (N = 484) 作为独立验证队列。我们根据治疗前放射线成像（正电子发射断层扫描 [PET] 与计算机断层扫描 [CT]）和使用事件定义和里程碑分析的早期 POD 状态对患者进行风险分层。一项竞争性风险分析评估了早期 POD 与组织学转化之间的关联。结果 在发现队列中，开始 R-CHOP 治疗后 24 个月内出现 POD 的患者 (PFS24)，CT 分期患者的 5 年 OS 为 57.6%，而 PET 分期患者的 5 年 OS 为 70.6%。在验证队列中，CT 分期和 PET 分期患者的早期 POD 患者的 5 年 OS 分别为 53.9% 和 100%。在开始治疗后一年内疾病进展的患者中，CT 分期患者的组织学转化风险高于 PET 分期患者（分别为 16.7% 和 6.3%），这与高出 9.7 倍的组织学转化风险相关。死亡。结论 在 FL 中，与 CT 分期相比，治疗前 PET 分期降低了早期 POD 的预后影响。早期 POD 且无组织学转化的患者通过标准治疗可延长 OS。