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Most follicular lymphoma comes back slowly and is treated again without much loss of life expectancy. For about one in five people it comes back within two years of the first chemotherapy, and that group needs a different plan, usually a biopsy first and then cellular or antibody treatment rather than more of the same.
The National LymphoCare Study followed 588 patients with stage 2 to 4 follicular lymphoma given first-line R-CHOP. Progression within two years of diagnosis happened in 19 per cent, and five-year overall survival in that group was 50 per cent against 90 per cent in everyone else; the effect held after adjusting for FLIPI (hazard ratio 6.44) and reproduced in an independent set of 147 patients. POD24 has since been shown with other induction regimens and is now the standard way of dividing follicular lymphoma into the part that behaves indolently and the part that does not.
What it changes. First, it triggers a repeat biopsy, because transformation to diffuse large B-cell lymphoma is the commonest reason for early progression and is treated as aggressive lymphoma, not as follicular lymphoma. Second, it moves the patient up the queue for treatment that works independently of chemotherapy sensitivity: CAR-T (axicabtagene ciloleucel or tisagenlecleucel) and the CD20 bispecific antibodies (mosunetuzumab, odronextamab, epcoritamab with rituximab and lenalidomide) all enrolled POD24 patients in numbers and reported response rates in them close to the whole-trial rates. Third, it is a reason to consider a clinical trial rather than a second line of chemoimmunotherapy.
POD24 is a description, not a diagnosis. It does not change the disease under the microscope, and a person who progresses at 25 months is not meaningfully different from one who progresses at 23.
Showing the molecule this term concerns: Lenalidomide.
Chemotherapy-free cellular therapy for follicular lymphoma that has stopped responding, with a toxicity profile mild enough that the treatment is deliverable outside the largest centres.
The number to give a patient deciding about maintenance: a median of six and a half extra years before the next treatment, and no difference in how long they live. Both halves belong in the conversation.
The single most used prognostic marker in follicular lymphoma, and the reason a relapse at 20 months is handled differently from one at 30 months. It is now a standard stratification factor and a standard eligibility criterion in trials of the disease.
Shares ZUMA-5, Odronextamab, Mosunetuzumab, The CAR-T pathway in lymphoma: referral, apheresis, bridging and the waiting.
Shares Watch and wait in lymphoma: when the right treatment is none yet, FLIPI, FLIPI2 and POD24 (follicular lymphoma risk), Mosunetuzumab, Rituximab.
Shares Mosunetuzumab, The CAR-T pathway in lymphoma: referral, apheresis, bridging and the waiting, Epcoritamab, Axicabtagene ciloleucel.
Shares Odronextamab, Mosunetuzumab with lenalidomide in relapsed marginal zone lymphoma, Mosunetuzumab, Marginal zone lymphoma.
Shares ZUMA-5, ELARA, Axicabtagene ciloleucel, Marginal zone lymphoma.
Shares Living with an indolent lymphoma rather than being cured of one, Watch and wait in lymphoma: when the right treatment is none yet, FLIPI, FLIPI2 and POD24 (follicular lymphoma risk), Marginal zone lymphoma.
Shares AUGMENT, Marginal zone lymphoma, Lenalidomide, Rituximab.
Shares Mosunetuzumab, Epcoritamab, Marginal zone lymphoma, Rituximab.