ASH 2023: MRD Status Predicts Progression-free Survival Outcomes in Follicular Lymphoma

The disease course in follicular lymphoma (FL) is highly variable, and it is currently difficult to predict which patients will experience long, durable responses and who will relapse quickly after treatment. Investigators therefore sought to determine whether minimal residual disease (MRD) status after initial therapy can be used to predict
survival outcomes in patients with advanced stage FL.

This study – presented by LRF grantee, LSRMP faculty member, and speaker for LRF Patient Education Programs Alexey Danilov, MD of City of Hope – used tissue samples collected during the SWOG S0016 trial, which was performed between 2001 and 2008. Investigators evaluated MRD status from bone marrow biopsies taken 1 year after the start of treatment (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone [R CHOP] or CHOP + I133-tositumomab [CHOP-RIT]. Response and survival rates were then compared between those with undetectable MRD and those with MRD positivity over up to 10 years of follow-up.

Among 116 patients included in the study, 83 achieved undetectable MRD and 33 remained MRD-positive. Compared with those who achieved MRD undetectability, MRD -positive patients were 6.5-times more likely to experience progression of disease within 24 months. After 5 years, 72% of MRD-undetectable patients remained progression free compared with 30% in the MRD-positive group. Higher rates of progression-free survival (PFS) were seen in the MRD-undetectable group relative to the MRD-positive group regardless of response status. Overall survival at 5 years was not significantly different between the two groups but was numerically higher in the MRDundetectable group (96% vs 81%). At 10 years, 56% of MRD-undetectable and 17% of MRD-positive patients remained progression free

The researchers noted that this represents the first time that MRD status has been shown to predict long-term PFS outcomes in patients with FL treated with initial chemotherapy, and suggest that MRD assessment may represent a promising tool for prognostication in FL.

This study also included contributions from LRF SAB members Lisa Rimsza, MD of Mayo Clinic, Arizona; Sonali Smith, MD of The University of Chicago; and Jonathan W. Friedberg, MD, MMSc of University of Rochester.