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.

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.”

Reference

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