Predicting EFS24 in Follicular Lymphoma

New research from the journal Blood could  be an important a step in predicting EFS24 in patients with Follicular Lymphoma.

EFS24 stands for Event Free Survival within 24 months, and it's an important way of predicting how aggressive a FL patient's cancer might be.

The idea is, if a patient has received immunochemotherapy (something like R-CHOP or R-B) and then has an event within 24 months, they tended to have a lower Overall Survival. Events can be things like progression of disease, relapse, or the need for retreatment. About 20% of FL patients seem to fall in this group. Research in the last few years has confirmed that EFS24 is a good predictor.

But here's the problem -- as of now, EFS24 status isn't known until patients have an event. In other words, patients get immunochemotherapy, and then have to wait for a couple of years to see if they have an event to figure out if they are in that 20%. It's a nerve-wracking wait (as some of you know, and as the rest of us can pretty easily imagine).

The next step in research on EFS24 is finding some way to predict, even before treatment starts, whether the patient is in that group.

That's what this research hopes to do, or at least start.

The researchers looked at over 1000 patients in the PRIMA trial, which has been examining the effectiveness of Rituxan Maintenance. They developed an index to predict Progression Free Survival using just two biomarkers: bone marrow involvement and the presence of Beta-2 microglobulin.

We all probably know what bone marrow involvement is (especially if we were unfortunate enough to have a bone marrow biopsy). Beta2m is a protein that is present in the blood when there is increased activity of cancer cells. It's an important predictor for multiple myeloma, another blood cancer -- higher levels usually mean a more aggressive disease and poorer outcomes.

The researchers found that bone marrow involvement and Beta2m levels can predict PFS in FL patients:
High risk: greater than 3mg/L of Beta2m, and a 37% 5 year PFS
Intermediate risk: less that 3mg/L of Beta2m, plus bone marrow involvement, with a 55% 5 year PFS
Low risk: less that 3mg/L of Beta2m, and no bone marrow involvement, with a 69% 5 year PFS

The researchers then looked at whether patients had events with 24 months, and found that the risks for EFS24 matched up well with their PFS index.

They then tested this idea on another group of patients in a different trial, and found that it their risk groups held up: 77% 5 year EFS  for the low-risk group, 57% for the intermediate, and 44% for the high.

The researchers admit that this is first step, and it "could serve as a basis for building more sophisticated and integrated biomolecular scores."

But it seems like a pretty good first step. Better models could build on this one and figure out other biomarkers that can make EFS24 easier to predict and, hopefully, treat more effectively.

Hope comes in small stages sometimes, but it builds up if you let it....