ASH: Bendamustine and Transformation

Another ASH preview.

But first, I want to alert you Cancer Nerds to The Leonard List. Lymphoma researcher Dr. Jon Leonard has been creating the Leonard List for the past few years. He lists what he thinks are the 10 most significant or interesting lymphoma-related abstracts from ASH. He posts them one a day on Twitter in the days leading up to ASH. But this year he also discussed them in a podcast, which you can listen to here. (He added 5 more to the podcast, so you get a nice bonus there.)

So, basically, he does what I do, except more of them, and a broader look at lymphoma and not just FL, and he's an actual expert, unlike me. But otherwise, the same thing. (I really enjoy Dr. Leonard's stuff on Twitter. He gives his followers lots to think about.)

The Leonard List includes a few ASH abstracts that focus on Follicular Lymphoma research, or issues related to FL, including this one: "Frontline Therapy with Bendamustine and Rituximab (BR) in Follicular Lymphoma: Prognosis Among Patients with Progression of Disease By 24 Months (POD24) Is Poor with Majority Having Transformed Lymphoma."

The study was conducted by researchers in British Columbia, Canada, where Bendamustine + Rituxan is the standard treatment now for patients with symptomatic, advanced FL. Before that, the standard treatment for these patients was R-CVP. The researchers wanted to see if B-R has been more effective than R-CVP.

And the short answer is that, yes, it has been more effective, which is what they expected. With a median follow-up of just under 3 years, they found that the 2 year Event Free Survival for the 296 patients receiving B-R was 85%, and the Overall Survival was 92%. Looking back at 347 R-CVP patients, the EFS was 76%, though the OS was the same. So B-R was better in keeping patients from having problems, but not in keeping them alive any longer.

The more interesting information came when they looked at patients that had transformed to an aggressive lymphoma.

In the B-R group 28 patients (about 9%) transformed from FL to an aggressive lymphoma. The 2 year OS for this group was only 39%.

They also looked at POD24, or Progression of Disease within 24 months after treatment with immunochemotherapy. This is sometimes called EFS24, or Event Free Survival within 24 months of immunochemo. Same basic concept. These patients generally have a worse outcome than other FL patients whose disease does not return within 24 months. In the B-R group, POD24 occurred in 35 patients (about 12%). That's a little lower than the 20% of patients found in some other studied. However, those 35 included 27 of the patients who had transformed. Overall, the 2 year OS for POD24 patients was 38%.

Compare that to the R-CVP group. In that group there were 77 POD24 patients -- about 22%, with 31 of those 77 patients having transformed.


So what does all of this mean? Well, first of all, it confirms that FL patients whose disease does not progress within 24 months generally have a very good long-term prognosis. But it also confirms that patients who do progress have a poor prognosis.  For patients taking B-R, the rate of transformation is about the same as with other treatments like R-CVP. However, the incidence of POD24 is lower -- Bendamustine might keep patients from having their disease return so quickly.

You can see that when you compare the POD24 numbers of the two treatments -- most of the POD24 patients for B-R also transformed. Transformation and POD24 are not always the same thing. So patients who have had POD24 happen haven't necessarily transformed.

The implication there is that B-R seems to do a good job of keeping advanced, asymptomatic FL from returning quickly. And for those that do have their FL return (as opposed to those who have transformed to something other than FL), "novel approahces specific to FL" might be used, instead of more aggressive treatments that are meant for transformed FL.

So while this probably isn't a "blockbuster," it does seem to give us some important information about that POD24/EFS24 population, and how it is (and is not) related to transformation. Plus, it made the Leonard List, so you know it's a good one.

More ASH stuff to come.