Early Relapse of Follicular Lymphoma After R‑CHOP Associated With Increased Mortality


Key Points

  • Five-year overall survival was significantly reduced in patients with progression of follicular lymphoma within 2 years of diagnosis.
  • The increased risk was confirmed in a validation cohort.

In an analysis from the National LymphoCare Study reported in the Journal of Clinical Oncology, Casulo et al found that disease progression within 2 years of diagnosis was associated with increased mortality risk after first-line R-CHOP (rituximab [Rituxan] plus cyclophosphamide, doxorubicin, vincristine, and prednisone) in patients with follicular lymphoma. It is estimated that 20% of follicular lymphoma patients experience progression of disease within 2 years of initial chemoimmunotherapy.

Study Details

The study involved data from 588 patients with stage II to IV disease who received first-line R-CHOP; 110 (19%) had progression within 2 years after diagnosis (early progression), 420 (71%) did not have progression within 2 years (reference group), 46 (8%) were lost to follow-up, and 12 (2%) died < 2 years after diagnosis without early progression. 

Overall Survival

Five-year overall survival was lower in the early progression group vs the reference group (50% vs90%), with a hazard ratio for death of 6.44 (95% confidence interval [CI] = 4.33–9.58) after adjustment for Follicular Lymphoma International Prognostic Index (FLIPI). In an independent validation cohort of 147 patients, 5-year overall survival was 34% vs 94%, with a hazard ratio for death of 19.8 (95% CI = 6.7-58.8) after adjustment for FLIPI score.

The investigators concluded: “In patients with [follicular lymphoma] who received first-line R-CHOP, [progression of disease] within 2 years after diagnosis was associated with poor outcomes and should be further validated as a standard end point of chemoimmunotherapy trials of untreated [follicular lymphoma]. This high-risk [follicular lymphoma] population warrants further study in directed prospective clinical trials.”

Jonathan W. Friedberg, MD, of University of Rochester, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by Genentech and F. Hoffmann-La Roche. For full disclosures of the study authors, visit

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