Prognostic value of circulating Bcl-2/IgH levels in patients with follicular lymphoma receiving first-line immunochemotherapy

BLOOD  126 (12)  : 1407 - 1414, 25 September 2015.

Fabian Zohren, Ingmar Bruns, Sabrina Pechtel, Thomas Schroeder, Roland Fenk, Akos Czibere, Georg Maschmeyer, Dorothea Kofahl-Krause, Norbert Niederle, Gerhard Heil, Christoph Losem, Manfred Welslau, Wolfram Brugger, Ulrich Germing, Ralf Kronenwett, Juergen Barth, Mathias J. Rummel, Rainer Haas, and Guido Kobbe . 

University Hospital Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Germany;

Klinikum Ernst von Bergmann, Potsdam, Germany;Medizinische Hochschule Hannover, Hannover, Germany; Klinikum Leverkusen, Leverkusen, Germany;Kreiskrankenhaus Lüdenscheid, Lüdenscheid, Germany;Onkologische Praxis Neuss, Neuss, Germany;Onkologische Praxis Aschaffenburg, Aschaffenburg, Germany;Schwarzwald-Baar-Klinikum Villingen, Villingen, Germany; and Justus-Liebig-Universität, Giessen, Germany

In this study the authors prospectively studied PB Bcl-2/IgH levels from 173 first-line FL patients who were consecutively enrolled, randomized, and treated within the multicenter phase 3 clinical trial NHL1-2003 comparing bendamustine-rituximab (B-R) with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone. From April 2005 to August 2008, 783 pre- and posttreatment PB samples were quantified by quantitative PCR. At inclusion, 114 patients (66%) tested positive and 59 (34%) were negative for Bcl-2/IgH. Their results show that high pretreatment Bcl-2/IgH levels had an adverse effect on progression-free survival (PFS) compared with intermediate or low levels (high vs intermediate: hazard [HR], 4.28; 95% confidence interval [CI], 1.70-10.77; P = .002; high vs low: HR, 3.02; 95% CI, 1.55-5.86; P = .001).  In this study, no PFS difference between treatment arms was observed in Bcl-2/IgH-positive patients. A positive post-treatment Bcl-2/IgH status was associated with shorter PFS. By multivariate analysis, the pretreatment Bcl-2/IgH level was the strongest predictor for PFS. Their data suggest that pre- and posttreatment Bcl-2/IgH levels from PB have significant prognostic value for PFS in FL patients receiving first-line immunochemotherapy. 

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