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Biomarkers for Risk Stratification in Patients With Previously Untreated Follicular Lymphoma Receiving Anti-CD20-based Biological Therapy.

Publication ,  Journal Article
Sohani, AR; Maurer, MJ; Giri, S; Pitcher, B; Chadburn, A; Said, JW; Bartlett, NL; Czuczman, MS; Martin, P; Rosenbaum, CA; Jung, S-H; Hsi, ED ...
Published in: Am J Surg Pathol
March 1, 2021

Follicular lymphoma (FL) is an indolent B-cell neoplasm of germinal center origin. Standard treatment regimens consist of anti-CD20 therapy with or without chemotherapy. While high response rates to initial therapy are common, patients ultimately relapse or have progressive disease. Clinical risk factors such as the Follicular Lymphoma International Prognostic Index (FLIPI) have been identified, but there is a need for prognostic and predictive biomarkers. We studied markers of lymphoma cells and tumor microenvironment by immunohistochemistry in tissue samples from patients enrolled in 1 of 4 phase 2 trials of anti-CD20-based biological therapy for previously untreated grades 1 to 2 or 3A FL. Results were correlated with progression-free survival (PFS) and PFS status at 24 months. The 4 trials included 238 patients (51.1% male, median age: 55 y) with stage III, IV, or bulky stage II disease. By FLIPI, 24.6% had low-risk, 56.8% had intermediate-risk, and 18.6% had high-risk disease. The outcome differed significantly for patients treated with lenalidomide and rituximab (CALGB 50803) compared with the other 3 trials (median: PFS not reached vs. 3.0 y, hazard ratio=3.47, 95% confidence interval: 2.11-5.72); therefore, data were stratified by clinical trial (CALGB 50803 vs. all others) and adjusted for FLIPI risk group. Among 154 patients with available tissue, interfollicular BCL6 positivity, interfollicular CD10 positivity, and elevated Ki67 proliferation index ≥30% within neoplastic follicles were each associated with inferior PFS and a high risk of the early event by PFS status at 24 months. We identify promising biomarkers for FL risk stratification that warrant further validation in phase 3 trials.

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Published In

Am J Surg Pathol

DOI

EISSN

1532-0979

Publication Date

March 1, 2021

Volume

45

Issue

3

Start / End Page

384 / 393

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Tumor Microenvironment
  • Treatment Outcome
  • Time Factors
  • Rituximab
  • Risk Factors
  • Risk Assessment
  • Recurrence
  • Proto-Oncogene Proteins c-bcl-6
 

Citation

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Sohani, A. R., Maurer, M. J., Giri, S., Pitcher, B., Chadburn, A., Said, J. W., … Hsi, E. D. (2021). Biomarkers for Risk Stratification in Patients With Previously Untreated Follicular Lymphoma Receiving Anti-CD20-based Biological Therapy. Am J Surg Pathol, 45(3), 384–393. https://doi.org/10.1097/PAS.0000000000001609
Sohani, Aliyah R., Matthew J. Maurer, Sharmila Giri, Brandelyn Pitcher, Amy Chadburn, Jonathan W. Said, Nancy L. Bartlett, et al. “Biomarkers for Risk Stratification in Patients With Previously Untreated Follicular Lymphoma Receiving Anti-CD20-based Biological Therapy.Am J Surg Pathol 45, no. 3 (March 1, 2021): 384–93. https://doi.org/10.1097/PAS.0000000000001609.
Sohani AR, Maurer MJ, Giri S, Pitcher B, Chadburn A, Said JW, et al. Biomarkers for Risk Stratification in Patients With Previously Untreated Follicular Lymphoma Receiving Anti-CD20-based Biological Therapy. Am J Surg Pathol. 2021 Mar 1;45(3):384–93.
Sohani, Aliyah R., et al. “Biomarkers for Risk Stratification in Patients With Previously Untreated Follicular Lymphoma Receiving Anti-CD20-based Biological Therapy.Am J Surg Pathol, vol. 45, no. 3, Mar. 2021, pp. 384–93. Pubmed, doi:10.1097/PAS.0000000000001609.
Sohani AR, Maurer MJ, Giri S, Pitcher B, Chadburn A, Said JW, Bartlett NL, Czuczman MS, Martin P, Rosenbaum CA, Jung S-H, Leonard JP, Cheson BD, Hsi ED. Biomarkers for Risk Stratification in Patients With Previously Untreated Follicular Lymphoma Receiving Anti-CD20-based Biological Therapy. Am J Surg Pathol. 2021 Mar 1;45(3):384–393.

Published In

Am J Surg Pathol

DOI

EISSN

1532-0979

Publication Date

March 1, 2021

Volume

45

Issue

3

Start / End Page

384 / 393

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Tumor Microenvironment
  • Treatment Outcome
  • Time Factors
  • Rituximab
  • Risk Factors
  • Risk Assessment
  • Recurrence
  • Proto-Oncogene Proteins c-bcl-6