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Biomarkers for Risk Stratification in Patients With Previously Untreated Follicular Lymphoma Receiving
Aliyah R Sohani1, Matthew J Maurer2, Sharmila Giri2
1Massachusetts General Hospital and Harvard Medical School, Boston, MA.
The American Journal of Surgical Pathology
|November 2, 2020
Summary
New biomarkers like BCL6 and Ki67 positivity in follicular lymphoma (FL) can predict treatment outcomes. These findings help stratify risk for patients with this indolent B-cell neoplasm.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Follicular lymphoma (FL) is an indolent B-cell neoplasm with standard treatments including anti-CD20 therapy.
- Despite initial high response rates, patients often experience relapse or disease progression.
- Existing clinical risk factors like FLIPI exist, but novel prognostic and predictive biomarkers are needed.
Purpose of the Study:
- To identify and validate novel biomarkers for risk stratification in previously untreated follicular lymphoma (FL).
- To correlate immunohistochemical markers in lymphoma cells and the tumor microenvironment with progression-free survival (PFS).
Main Methods:
- Analysis of tissue samples from 238 patients in 4 phase 2 trials of anti-CD20-based therapy for FL.
- Immunohistochemistry was used to assess markers including BCL6, CD10, and Ki67 proliferation index.
- Results were correlated with PFS and PFS status at 24 months, with data stratified by clinical trial and adjusted for FLIPI risk.
Main Results:
- Among 154 patients with available tissue, interfollicular BCL6 positivity, interfollicular CD10 positivity, and elevated Ki67 (≥30%) were associated with inferior PFS.
- These markers also indicated a high risk of early events, as assessed by PFS at 24 months.
- Outcomes differed significantly between patients treated with lenalidomide and rituximab versus other regimens.
Conclusions:
- Interfollicular BCL6 positivity, interfollicular CD10 positivity, and elevated Ki67 proliferation index are promising biomarkers for FL risk stratification.
- These identified biomarkers warrant further validation in larger phase 3 clinical trials to improve patient management.
