OBJECTIVES: CAR T-cells have recently been approved in relapsed/refractory follicular lymphoma (FL) but few real-world data exist. Primary objective was to describe the different treatment lines of FL patients from 2015 to 2020 in France. Secondary objectives were to estimate time to next treatment (TTNT) and overall survival (OS).

METHODS: This was a retrospective cohort study based on medico-administrative data of the French National Health System database (SNDS). All adult patients treated for symptomatic FL (index date) were included and followed from January 2015 to February 2020 or death or transformation into DLBCL. An artificial intelligence algorithm (ATLAS) and Aalen Johansen estimator were used to identify the different treatment lines and durations.

RESULTS: 17 102 FL treated patients were included in the study with a stability of incidence between 2015-2020 and an increase of patients treated in advanced lines. Median age was 67 years, 47% were women. 73% were treatment-naïve or without treatment for a FL at least 5 years before index date and 7% had a DLBCL transformation. Mean time to first treatment initiation was 5 (0-120) months and 12% had a time to first treatment initiation greater than 6 months. In 2019, 2 097, 643, 241, 131 patients initiated 1L (first line), 2L, 3L, 4L+, respectively. After 33 months of follow-up, median TTNT was not reached in 1L / 2L and was 22 / 15 months in 3L / 4L, respectively. 3y OS at 4L was 63%.

CONCLUSIONS: Results are consistent with literature, however, due to the maximal follow-up of 5 years, the indolence of the disease and the good efficacy for most patients in 1L, a certain proportion of long-term responders could potentially not be identified, leading to under-estimation of TTNT and misidentification of line of treatment. This study reflects French real-world practices and will brings support to the reimbursement assessment.