Impact and utility of follicular lymphoma GELF criteria in routine care: an Australasian Lymphoma Alliance study
Allison Barraclough,
Shivam Agrawal,
Dipti Talaulikar,
Geoffrey Chong,
Edward Yoo,
Chan Y. Cheah,
Nunzio Franco,
Bianca Nguyen,
Howard Mutsando,
Fatima Tahir,
Judith Trotman,
Jing Huang,
Colm Keane,
Mitchel Lincoln,
Tara Cochrane,
Anna M. Johnston,
Michael Dickinson,
Stephen Opat,
Zoe K. McQuilten,
Erica M. Wood,
Gayathri St George,
Eliza A. Hawkes
Affiliations
Allison Barraclough
Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Victoria, Australia; Fiona Stanley Hospital, Western Australia
Shivam Agrawal
Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Victoria, Australia; Prince of Wales Hospital, New South Wales
Dipti Talaulikar
Canberra Health Services, Australian Capital Territory, Australia; College of Health and Medicine, Australian National University, Australian Capital Territory
Geoffrey Chong
Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Victoria, Australia; Ballarat Regional Integrated Cancer Centre, Ballarat Health Services, Victoria
Edward Yoo
Fiona Stanley Hospital, Western Australia, Australia; Sir Charles Gairdner Hospital, Western Australia
Chan Y. Cheah
Sir Charles Gairdner Hospital, Western Australia, Australia; Medical School, University of Western Australia, Western Australia
Nunzio Franco
Canberra Health Services, Australian Capital Territory, Australia; College of Health and Medicine, Australian National University, Australian Capital Territory
Bianca Nguyen
Fiona Stanley Hospital, Western Australia
Howard Mutsando
Toowoomba Hospital, Queensland, Australia; University of Queensland Rural Clinical School, Queensland
Fatima Tahir
Concord Repatriation General Hospital, University of Sydney, New South Wales
Judith Trotman
Concord Repatriation General Hospital, University of Sydney, New South Wales
Jing Huang
School of Clinical Sciences at Monash Health, Monash University, Victoria
Colm Keane
Princess Alexandra Hospital, Queensland
Mitchel Lincoln
Alfred Hospital, Victoria
Tara Cochrane
Gold Coast University Hospital, Queensland, Australia; School of Medicine, Griffith University, Queensland
Anna M. Johnston
Royal Hobart Hospital, Tasmania
Michael Dickinson
Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Victoria
Stephen Opat
School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria
Zoe K. McQuilten
School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria
Erica M. Wood
School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria
Gayathri St George
School of Public Health and Preventive Medicine, Monash University, Victoria
Eliza A. Hawkes
Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria
Follicular Lymphoma (FL) treatment initiation is largely determined by tumor burden and symptoms. In the pre-rituximab era, the Group d’Etude des Lymphomes Folliculaires (GELF) developed widely adopted criteria to identify high tumor burden FL patients to harmonize clinical trial populations. The utilization of GELF criteria (GELFc) in routine therapeutic decision-making is poorly described. This multicenter retrospective study evaluated patterns of GELFc at presentation and GELFc utilization in therapeutic decision-making in newly diagnosed, advanced stage rituximab-era FL. Associations between GELFc, treatment given, and patient survival were analyzed in 300 eligible cases identified between 2002-2019. 163 (54%) had ≥1 GELFc at diagnosis. The presence or cumulative number of GELFc did not predict PFS in patients undergoing watch-and-wait (WW) or those receiving systemic treatment. Of interest, in patients with ≥1 GELFc, 16/163 (10%) underwent initial watch-and-wait (comprising 22% of the watchand- wait cohort). In those receiving systemic therapy +/- radiotherapy, 74/215 (34%) met no GELFc. Our data suggest clinicians are using adjunctive measures to make decisions regarding treatment initiation in a significant proportion of patients. By restricting FL clinical trial eligibility only to those meeting GELFc, reported outcomes may not be applicable to a significant proportion of patients treated in routine care settings.
