284P - Differences in disease characteristics and survival outcomes of follicular lymphoma in young adults and older population: An institutional analysis

Background

Follicular Lymphoma (FL) is known to be a disease of the elderly and younger patients are postulated to have distinct tumor biology and treatment outcomes. Various lymphoma groups across the world have studied this to understand if young adults (YA) need a different treatment approach. Our study fills the void in paucity of data from an Asian country on YA versus older population of Follicular Lymphoma.

Methods

The records of patients presented at our center between 2012 and 2018 were retrospectively reviewed. They were stratified by age into ≤40 (YA) and > 40 years and their demographics, clinicopathological features and outcomes were analyzed.

Results

A total of 167 patients of follicular lymphoma were identified with 24 (14.3%) patients belonging to YA group. A final analysis of 154 patients is presented after excluding patients with upfront Grade 3b disease. Median age in YA and older patients was 37 and 55 years respectively. YA group had a higher incidence of extranodal involvement, bone marrow involvement, and advanced disease at presentation, whereas high LDH and low hemoglobin levels were more common in older patients. As per FLIPI risk scoring, 43% of our patients in both groups had high-risk disease. All YA received treatment upfront, while 7.7% of older population underwent observation. Most commonly used chemotherapy regimen was CVP and 46% of our patients received Rituximab. The ORR was significantly more in YA population (91.3% vs 83.2%) At a median follow-up of 3.5 and 3.2 years (YA and >40 years respectively), YA had a better median PFS (3.5 yrs) and OS (5.9 yrs) compared to those older than 40 (PFS 3.1 yrs, OS 5.2 yrs). On multivariate analysis, normal LDH, lower FLIPI score and use of Rituximab were associated with a significantly longer PFS in older patients, however, it showed a trend towards improved PFS in young adult population that did not reach statistical significance. No parameter showed a significant association with OS.

Conclusions

YA more frequently present with advanced stage requiring upfront treatment, however they exhibit higher ORR and better PFS and OS compared to older counterparts. The survival rates seen are comparable to another Indian study but lower than the Western data.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.