Researchers define unique group of high-risk lymphoma patients

The difference underscores the fact that about 20 percent of follicular lymphoma patients consistently experience their disease coming back within two years of being treated with the latest therapies--despite the fact that most follicular lymphoma patients can expect to live 20 years.

People who relapse early may have a disease with distinctly different biology, said Carla Casulo, M.D., a Wilmot oncologist and assistant professor of Medicine at the University of Rochester, who led the study. The findings are published online by the Journal of Clinical Oncology and will be accompanied by an editorial in JCO's print edition later this summer.

Usually this type of blood cancer is slow-growing, with long periods of remission followed by late relapses and more treatment. Until now, it was not scientifically confirmed that the patients in the 20-percent group also have very poor survival outcomes; 50 percent of these patients die in five years.

Follicular lymphoma is the second most common non-Hodgkin lymphoma, affecting approximately 15,000 people a year in the United States. The Wilmot study recommends that early relapse should be carefully considered when oncologists and patients are making decisions about treatment.

"Through research we have confirmed that all relapsed patients are not equal, and therefore should not be approached the same at diagnosis nor at the time of relapse in terms of therapies," Casulo said. "It will be critical to predict who is most likely to relapse early. We believe that targeted sequencing or gene-expression profiling will be important to understanding how to improve the outcomes of this group."

Investigators, including co-author Jonathan W. Friedberg, M.D., director of the Wilmot Cancer Institute, came to their conclusions after analyzing data from 588 patients with stage 2-4 follicular lymphoma and confirming the findings in an independent patient cohort.

The research has already been presented as a talk at the American Society of Hematology (ASH) annual meeting and highlighted as one of the most important abstracts presented. The National Cancer Institute is also starting to develop clinical trials for this high-risk, early-relapsing subgroup of follicular lymphoma patients.