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ASH 2024 | Outcomes of R-CHOP versus BR in follicular lymphoma based on PET SUVs
Patrizia Mondello, MD, PhD, Mayo Clinic, Rochester, MN, discusses a study that compared the efficacy of frontline R-CHOP with bendamustine and rituximab (BR) based on the standardized uptake value (SUV) on positron emission tomography (PET) scans in newly diagnosed follicular lymphoma 1-2 and 3A. The study concluded that SUVs are not prognostic of survival in those treated with R-CHOP versus BR. Therefore, it did not provide evidence to classify, based on SUV, the choice of treatment for patients with follicular lymphoma 1-3A. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI-generated)
PET scan imaging is the imaging of choice for the newly staging and reassessment of therapy of follicular lymphoma. Currently, the quantitative markers of the PET scan, such as SUV, are used as prognostic markers to identify whether a disease might be more aggressive and specifically was associated with high SUV with the propensity to be a more aggressive disease. So nevertheless, there are not established data that can identify an anthracycline treatment such as R-CHOP compared to BR as more effective in this specific subset...
PET scan imaging is the imaging of choice for the newly staging and reassessment of therapy of follicular lymphoma. Currently, the quantitative markers of the PET scan, such as SUV, are used as prognostic markers to identify whether a disease might be more aggressive and specifically was associated with high SUV with the propensity to be a more aggressive disease. So nevertheless, there are not established data that can identify an anthracycline treatment such as R-CHOP compared to BR as more effective in this specific subset. Therefore, we decided to investigate the impact of R-CHOP versus BR in newly diagnosed follicular lymphoma 1-2 and 3A that are treated within six months with these two regimens of immunochemotherapy. To do so we use two prospective multi-center cohorts called LEO and MER cohorts. We use two clinical trials specific to the FOLL12 and the immunochemotherapy arm of the RELEVANCE trial and a retrospective cohort of 13 Australian centers. What we found is, first of all, that there was a prevalence of BR treatment in the Australian and the MER and LEO American cohorts compared to the R-CHOP, while the opposite was observed for the FOLL12 and the RELEVANCE trial which are European studies. We did not find any significant impact of high SUV on the outcome overall. Before we decided to investigate specifically the treatment based on the different level of SUV and to do so we divided SUV into tertiles. We found that R-CHOP had an inferior event-free survival in the lowest and middle tertile compared to BR, but R-CHOP had also a significant better overall survival in the same setting. We did not find any difference for R-CHOP and BR in the highest tertile. We further subdivided and did multiple comparisons, but we concluded that the SUV overall does not impact survival based on R-CHOP or BR treatment. So in conclusion, this is one of the largest multi-center studies that did not provide evidence to classify, based on SUV, the choice of treatment for patients with follicular lymphoma 1-3A.
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