ICML 2023 | FOLL12: MRD and PET as prognostic tools for follicular lymphoma
Simone Ferrero, MD, University of Turin and Hospital “Città della Salute e della Scienza di Torino”, Turin, Italy, shares the findings from a recent analysis of the FOLL12 trial (NCT02063685) which investigated response-driven maintenance therapy following R-CHOP and R-bendamustine for follicular lymphoma (FL). Dr Ferrero focuses on the prognostic roles of PET scans and measurable residual disease (MRD) and highlights that, when combined, these tools can be predictive of an increased risk of relapse, for instance in patients who are PET-negative but remain MRD-positive after achieving complete molecular response. This interview took place at the 17th International Conference on Malignant Lymphoma (ICML), held in Lugano, Switzerland.
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Transcript (edited for clarity)
Yesterday we presented the results of a combined experience of MRD analysis and PET results in a Phase III trial sponsored by Fondazione Italiana Linfomi on first-line follicular lymphoma. Patients were randomized to receive treatment with either R-CHOP or R-bendamustine according to physician choice and then were randomized to receive a maintenance modulated on the basis of MRD. What we show is that both PET response at the end of induction and MRD response at the end of induction measured both on bone marrow or peripheral blood, are independent prognosticators for PFS in follicular lymphoma...
Yesterday we presented the results of a combined experience of MRD analysis and PET results in a Phase III trial sponsored by Fondazione Italiana Linfomi on first-line follicular lymphoma. Patients were randomized to receive treatment with either R-CHOP or R-bendamustine according to physician choice and then were randomized to receive a maintenance modulated on the basis of MRD. What we show is that both PET response at the end of induction and MRD response at the end of induction measured both on bone marrow or peripheral blood, are independent prognosticators for PFS in follicular lymphoma. They also independently predict POD24 for PET positive patients and MRD positive patients. And finally, we studied the combination of both markers, and we found that if at the end of the induction, the prognostic value of PET prevails, then if we continue monitoring over time every six months until month 36 after the achievement of complete molecular remission, if we monitor MRD, a positivity of any MRD samples in this window without treatment or under rituximab maintenance is predictive for an excess risk of progression-free survival. So, for example, if you are MRD positive in peripheral blood at 36 months after the achievement of complete molecular remission, you have a five-fold risk of relapse.
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