Follicular Lymphoma: Refining Prognostic Models and Impact of Pod-24 in Clinical Outcomes

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2022-02, Vol.22 (2), p.67-75
• Main Authors: Nogueira, Daniel Silva, Lage, Luís Alberto de Pádua Covas, Culler, Hebert Fabrício, Pereira, Juliana
• Format: Article
• Language: English
• Subjects: Follicular lymphoma; Hematopoietic Stem Cell Transplantation; Humans; Immunochemotherapy; Lymphoma, Follicular - drug therapy; Lymphoma, Follicular - therapy; Neoplasm Recurrence, Local - drug therapy; Prognosis; Prognostic models; Progression of disease within 24 months; Risk assessment; Transplantation, Autologous
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2021.08.004

Follicular lymphoma (FL) is the most common indolent lymphoma, accounting for 20%-25% of all non–Hodgkin's lymphomas (NHLs). It is a malignancy with variable biologic presentation and heterogeneous clinical outcomes. Several models incorporating clinical laboratory variables and molecular biomarkers are able to predict its prognosis, allowing to stratify patients into different risk groups. However, these prognostic scores should not be used to indicate first-line treatment or risk-adapted therapeutic recommendations. Over the past 5 years, progression of disease within 24 months (POD-24) of first-line chemo-immunotherapy has emerged as a robust adverse prognostic factor, capable of assessing overall survival and identifying high-risk patients with indication for more aggressive therapeutic approaches, such as consolidation based in autologous stem cell transplantation. It should be reinforced that POD-24 is not a baseline measurement, it is based on a post-treatment strategy, and is usually applied to patients with a high tumor burden. The identification of newly diagnosed patients at high risk for disease progression, particularly those with low tumor volume is still a challenge in the context of FL. Therefore, the primary purpose of this review is to provide an overview of the main prognostic models validated to date for FL. Moreover, using these scores, which incorporate clinical and genetic variables, we aim to identify individuals with newly diagnosed FL, advanced disease, and low tumor burden with a high probability of progression or relapse within 24 months of first treatment. Thus, a decision regarding risk-adapted induction therapy could be better stablished for these subset of patients.