Treatment and survival outcomes for patients with follicular lymphoma and POD24: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Heterogeneity p-values: CAR T ORR p=0.0414, CAR T CR p<0.0001

• Effect Size: CAR T-cell therapy: ORR 91.2%, CR 75.7%; Bispecific antibodies: ORR 81.6%, CR 65.7%

• Primary Outcome: Overall response rate and complete response rate across different treatment modalities

• Nnt Or Sensitivity: Anti-CD19 CAR T-cell therapy achieved highest complete response rates among evaluated therapies

• Confidence Interval: CAR T ORR: 83.7-98.7%; CAR T CR: 55.1-96.4%; Bispecific ORR: 75.9-87.3%; Bispecific CR: 57.1-74.3%

Clinical Application

Limited by availability of CAR T-cell therapy and novel agents; requires specialised haematology centres CAR T-cell therapy available through PBS for certain indications; bispecific antibodies emerging through clinical trials and compassionate access programs Patients with follicular lymphoma experiencing early progression (POD24) requiring salvage therapy

Abstract

Follicular lymphoma with progression of disease within 24 months (POD24) is associated with poor prognosis and represents clinical challenges. Therefore, we performed a systematic review and pooled analysis of patients with POD24. Twenty-one trials involving 1242 participants were included, assessing the overall response rate (ORR), complete response (CR), duration of response, and progression-free survival. In some trials, we compared pooled response rates between POD24 and non-POD24 populations with the same treatment regimen. Four trials evaluated chimeric antigen receptor (CAR) T-cell therapy in patients with POD24. Pooled analysis showed an ORR of 91.2% (95% confidence interval [CI], 83.7-98.7) with significant heterogeneity (P = .0414; I2 = 68.61%) and a CR of 75.7% (95% CI, 55.1-96.4) with significant heterogeneity (P< .0001; I2 = 93.99%). The specific response rates for different bispecific antibodies in POD24 were pooled analysis, the ORR was 81.6% (95% CI, 75.9-87.3) with no heterogeneity (P = .6958; I2 = 0%), and the CR was 65.7% (95% CI, 57.1-74.3) with moderate heterogeneity (P = .2148; I2 = 34.99%). For anti-CD19 antibody-drug conjugates (ADCs)/monoclonal antibodies (mAbs), the ORR and CR rate for loncastuximab plus rituximab and tafasitamab plus R2 (lenalidomide + rituximab) were 100% and 79.3%, and 87.5% and 43.2%, respectively. Phosphatidylinositol 3-kinase inhibitors and anti-CD20 mAb-containing regimens were also analyzed in pooled analyses. Our results demonstrated that anti-CD19 CAR T-cell therapy achieved the highest CR rate. Additionally, bispecific antibodies, anti-CD19 ADCs/mAbs, and the combination of lenalidomide with obinutuzumab or rituximab also exhibited excellent efficacy. Notably, lenalidomide plus obinutuzumab showed superior efficacy compared with R2.

References

1. 1.Shen, J., Zhang, J., Zhu, Z., Ma, H., Zhang, J., Zhou, F., Tian, H., & Liu, J. (2026). Treatment and survival outcomes for patients with follicular lymphoma and POD24: a systematic review and meta-analysis. Blood Advances. https://doi.org/10.1182/bloodadvances.2025018474