Analysis of Real‐World Treatment Patterns and Outcomes Among Patients With Relapsed/Refractory Follicular Lymphoma Including POD24 Patients
Bibliographic record
Abstract
Introduction: Although follicular lymphoma (FL) is an indolent disease, there is much heterogeneity in outcomes. Patients with early relapsed disease within 24 months (POD24) have been reported to be a poor prognostic subgroup, although this finding has not been confirmed in several recent real-world studies. This study describes treatment patterns, prognostic factors, and outcomes in patients with relapsed/refractory (R/R) FL, including those who progress through multiple lines of therapy (LOTs). Methods: This study was conducted using the COTA database, which is comprised of electronic health records drawn from academic centers (50%) and community practices (50%) in the US. Patients included in this study had a confirmed diagnosis of FL (index date) between 1 January 1990 and 31 December 2022, were ≥18 y of age at index date, were administered treatment for FL, and were followed >3 months after first-line (L) treatment initiation. The utilization of novel treatment options was captured progressively throughout the study period. Patients who progressed from 1L chemoimmunotherapy (CIT) within 24 months were identified as POD24 patients. A landmark approach was taken to assess the overall survival (OS) of the POD24 patients who had at least 24 months of follow-up from 1L CIT versus non-POD24 patients as described in previous studies (Casulo et al., Blood 2022). Patient demographics, treatment patterns, and OS were also assessed by LOT. Results: Overall, 3568 FL patients met inclusion criteria. Among these, 2465 received 1L CIT, with 459 (18.6%) identified as POD24. Of these POD24 patients, 264 had ≥24 months of follow-up from 1L CIT and were included in the landmark analysis. This sub-group of POD24 patients had a median age of 64 y at diagnosis and 86.6% had stage III/IV disease. Non-POD24 patients (n = 2006) had a median age of 61 y at diagnosis and 81.4% had stage III/IV disease. POD24 patients had worse OS (hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.79, 2.80) versus non-POD24 patients. Of the 3568 1L FL patients, 862 continued to 2L, 328 continued to 3L, 146 continued to 4L, and 59 continued to 5L+ treatment. Across all LOTs, the most common therapy was rituximab or obinutuzumab + chemotherapy. The utilization of novel treatments (ie, kinase inhibitors, CAR T-cell therapy, tazemetostat) increased through LOTs, with 6.4% utilization at 3L, 9.6% at 4L, and 20.7% at 5L. Patients who progressed through successive LOTs experienced worsening OS (Figure 1). The research was funded by: This study was funded by Genmab A/S and AbbVie Inc. Keywords: Cancer Health Disparities, Late Effects in Lymphoma Survivors Conflicts of interests pertinent to the abstract. L. H. Sehn Consultant or advisory role: AbbVie, Bayer, BeiGene, BMS/Celgene, Epizyme, Genentech/Roche, Genmab, Incyte, Janssen, Kite/Gilead, Loxo, Miltenyi, MorphoSys, Novartis, Rapt, Regeneron, Takeda A. Wang Employment or leadership position: AbbVie Stock ownership: AbbVie J. Yu Employment or leadership position: AbbVie R. Kamalakar Employment or leadership position: AbbVie K. Sail Employment or leadership position: AbbVie Stock ownership: AbbVie W. Sinai Employment or leadership position: AbbVie Stock ownership: AbbVie D. Arnette Employment or leadership position: AbbVie S. Yang Employment or leadership position: Genmab A. Mutebi Employment or leadership position: Genmab Stock ownership: Genmab F. R. Navarro Employment or leadership position: Genmab G. Salles Consultant or advisory role: AbbVie, Bayer, BeiGene, BMS/Celgene, Epizyme, Genentech/Roche, Genmab, Incyte, Janssen, Kite/Gilead, Loxo, Miltenyi, MorphoSys, Novartis, Rapt, Regeneron, Takeda
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".