Incidental Follicular Lymphoma Diagnosis Associated With Earlier-Stage Disease

Compared with patients who have lymphoma-related symptoms, patients who have an incidental, asymptomatic diagnosis of follicular lymphoma (FL) are more likely to have early-stage disease and more favorable disease characteristics. However, no association was found between diagnosis type and survival outcomes.

Suheil Albert Atallah-Yunes, MD, of the Mayo Clinic, and colleagues reported their results in Blood Cancer Journal, investigating the role of multi-cancer early detection tests (MCEDs) on patient outcomes.

“Multi-cancer early detection tests have shown promise in identifying lymphomas, including FL, at early stages through blood-based assays,” Dr. Atallah-Yunes told Blood Cancers Today. “Our study may serve as a surrogate for what MCEDs might detect.”

To compare disease characteristics and outcomes among patients diagnosed incidentally versus symptomatically, the researchers reviewed 908 patients with newly diagnosed FL enrolled in the Molecular Epidemiology Resource from 2002 to 2015. A total of 259 patients (28.5%) were diagnosed incidentally without symptoms, and 649 patients (71.5%) had lymphoma-related symptoms.

Patients with an incidental diagnosis were more likely to have stage I or II disease (43.2% vs 30.6%, respectively; P= 0.0003), normal lactate dehydrogenase levels (87.2% vs 80.8%, respectively; P=0.03), and lower Follicular Lymphoma International Prognostic Index (FLIPI) scores (49.8% vs 42.2%, respectively; P= 0.1) compared with those with a symptomatic diagnosis.

However, the rates of event-free survival (hazard ratio [HR], 1.01; 95% CI, 0.80-1.27; P=0.93), overall survival (HR, 0.93; 95% CI, 0.68-1.28; P=0.66), and lymphoma-specific survival were comparable between the two groups.

“In FL, early detection doesn’t automatically translate into improved outcomes under current treatment paradigms, as a watch-and-wait strategy remains appropriate for many patients,” Dr. Atallah-Yunes told Blood Cancers Today.

Patients in the incidental group received less immunochemotherapy and were more likely to be observed compared with the symptomatic group, the researchers noted.

“The real question is whether detecting FL at a preclinical molecular stage, earlier than our incidentally diagnosed group, would lead to different results and outcomes than those observed in our study. That remains unanswered, and future studies must weigh the benefits of earlier detection against risks of overtreatment, patient psychosocial factors and healthcare costs,” Dr. Atallah-Yunes added. “The ultimate value of MCEDs in FL will depend on whether early intervention can meaningfully improve outcomes. Until such data emerge, clinical decision-making must continue to balance early identification with the principles of patient-centered care.”