Leukemia/Lymphoma/Hematologic

SS 35 - Hematologic 3 -?Translating Better Technology to Improved Outcome in Primary and Relapsed Disease

251 - Definitive and Immediate Salvage Treatment Achieves Durable Response for Relapse Following Primary RT for Follicular Lymphoma: An International Collaborative Study on Behalf of ILROG

Wednesday, October 24
7:45 AM - 7:55 AM
Location: Room 007 A/B

Definitive and Immediate Salvage Treatment Achieves Durable Response for Relapse Following Primary RT for Follicular Lymphoma: An International Collaborative Study on Behalf of ILROG
M. S. Binkley1, J. L. Brady2, G. Mikhaeel3, and R. T. Hoppe4; 1Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, 2Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom, 3Cancer Division, King's College London, London, United Kingdom, 4Stanford University School of Medicine, Stanford, CA

Purpose/Objective(s): We previously reported outcomes for a cohort of patients (pts) with early stage follicular lymphoma (FL) staged by FDG-PET receiving definitive primary radiation therapy (RT) of whom approximately 30% developed recurrence within 5 years. Treatment for relapsed lymphoma after primary RT varies significantly. We sought to report outcomes for pts in this cohort who relapsed.

Materials/Methods: We conducted a multicenter retrospective study of pts who received RT only for stage I-II FL staged by PET-CT meeting inclusion criteria: ≥18 years, grade 1-3A FL, dose ≥24Gy without prior treatment. We analyzed outcome of pts with relapse excluding those with <3 months of follow up from time of failure. Overall survival (OS) and freedom from progression (FFP) were estimated with Kaplan-Meier, and uni- and multivariate analyses with Cox regression. Observation was defined as >6 months from failure without treatment.

Results: Of 512 pts with median follow up of 52 months, 149 developed recurrent lymphoma at a median 23 months (range, 1-143) after primary RT. 137 (91.9%) were distant failures. Histologies included: 90 indolent, 3 FL grade 3B/NOS, 19 diffuse large B-cell lymphoma (DLBCL), and 37 un-biopsied. 109 pts had sufficient follow up (median, 37 months) with 3-year OS of 95.9% from time of relapse. The majority (n=96, 88%) had biopsied (n=73) or presumed (n=23) indolent recurrence and received the following: 57 (59.4%) observation, 20 (20.8%) systemic therapy, 15 (15.6%) RT, and 4 (4.2%) systemic and RT. For indolent recurrences, 3-year FFP or time to next treatment was significantly better for those who received salvage treatment compared with observation, 82.3% vs 57.7%, respectively (p=0.03), with no significant difference in age, gender, localized relapses, biopsy status, or symptoms between subgroups. For those observed, median time to treatment or progression was 21 months (range, 8-56) with 19 receiving salvage treatment and continued observation for the remainder. For all pts with indolent recurrence receiving salvage treatment (n=58), 3-year FFP was 77.9%; 35 were eligible for definitive treatment (RT≥24 Gy, chemotherapy with rituximab, or chemoradiation) with 3-year FFP of 94.4%. 23 received RT<24 Gy or rituximab alone with 3-year FFP of 57.4%. On multivariate analysis, initial observation status was associated with worse FFP (HR=3.22, p=0.03) after adjusting for pt factors at relapse. 9 pts with DLBCL and sufficient follow up received salvage treatment (7 chemotherapy, 2 chemoradiation) for which 6 remain disease free.

Conclusion: Based on this cohort with limited follow up, a significant proportion of patients with relapsed lymphoma after primary RT for early stage FL achieved remission with excellent OS. Pts with indolent recurrence had superior FFP with immediate treatment, and those selected for definitive treatment attained a durable response.

Author Disclosure: M.S. Binkley: None. J.L. Brady: None. G. Mikhaeel: None. R.T. Hoppe: Employee; Stanford University. Honoraria; NCCN. Board Member; ISCL.

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