Minimal residual disease (MRD) status predicted prognosis in patients with early-stage follicular lymphoma, reported a retrospective, single-institution analysis. The results of the analysis were published in 2019 in the British Journal of Haematology and suggest thatmonitoring for MRD in patients with early-stage follicular lymphoma may help predict prognosis and even guide the decision to pursue rituximab treatment.1

The retrospective analysis included 67 patients from a single institution who were consecutively diagnosed with stage I/II follicular lymphoma between 2000 and 2016. The presence of BCL2/IGH rearrangements was assessed in each patient at diagnosis, and 72% of patients were BCL2/IGH-positive.

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As for treatment received, initially, all of the patients got involved-field radiotherapy (IF-RT), but starting in 2005, patients were treated further with rituximab if they had MRD after radiotherapy.

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The analysis revealed that half of patients achieved MRD negativity after IF-RT, and 84% of patients who were MRD-positive after radiotherapy went on to achieve MRD negativity with rituximab. Among MRD-positive patients, those who received rituximab had a significantly improved progression-free survival (PFS) compared with those who did not receive rituximab (P =.049).

In addition, the analysis showed that patients who remained MRD-negative had significantly improved PFS compared with MRD-positive patients (median not reached vs 67 months) (P =.0038). Patients who had undetectable or low levels of circulating BCL2/IGH-positive cells at the time of diagnosis also had significantly improved PFS.

“In early-stage FL [follicular lymphpma], both circulating levels of BCL2/IGH+ cells at diagnosis and MRD status during follow-up bear prognostic implications,” the study authors wrote.

They also asserted that their study indicates that an MRD-driven consolidation with rituximab after standard IF-RT “improves the PFS of patients with early-stage FL.”


Pulsoni A, Della Starza I, Cappelli LV, et al. Minimal residual disease monitoring in early stage follicular lymphoma can predict prognosis and drive treatment with rituximab after radiotherapy [published online August 5, 2019]. Br J Haematol. doi: 10.1111/bjh.16125