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Sorigue M, Sancho JM. Current prognostic and predictive factors in follicular lymphoma. Ann Hematol 2017; 97:209-227. [PMID: 29032510 DOI: 10.1007/s00277-017-3154-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/09/2017] [Indexed: 12/27/2022]
Abstract
Follicular lymphoma (FL) is generally considered an indolent disorder. With modern day treatments, long remissions are often achieved both in the front-line and relapsed setting. However, a subset of patients has a more aggressive course and a worse outcome. Their identification is the main purpose of modern day prognostic tools. In this review, we attempt to summarize the evidence concerning prognostic and predictive factors in FL, including (1) pre-treatment factors, from baseline clinical characteristics and imaging tests to histological grade, the microenvironment and genomic abnormalities; (2) post-treatment factors, i.e., depth of response, measured both by imaging tests and minimal residual disease; (3) factors at relapse and duration of response; and (4) prognostic factors in histological transformation. We conclude that, despite the existence of numerous tools, the availability of some of them is still limited; they generally suffer from notable downsides, and most have unproven predictive value, thus having scarce bearing on the choice of regimen at present. However, with the technological and scientific developments of the last few years, the potential for these prognostic factors is promising, particularly in combination, which will probably, in time, help guide therapeutic decisions.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols
- Bone Marrow/drug effects
- Bone Marrow/metabolism
- Bone Marrow/pathology
- Chromosomes, Human, Pair 14/chemistry
- Chromosomes, Human, Pair 18/chemistry
- Clinical Trials as Topic
- Disease-Free Survival
- Humans
- Lymphoma, Follicular/diagnostic imaging
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/mortality
- Mutation
- Neoplasm Grading
- Neoplasm, Residual/diagnostic imaging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/genetics
- Neoplasm, Residual/mortality
- Positron-Emission Tomography
- Prognosis
- Recurrence
- Risk Factors
- Translocation, Genetic
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Ctra. Canyet, 08916, Badalona, Spain.
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Ctra. Canyet, 08916, Badalona, Spain
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Carreras J, Lopez-Guillermo A, Roncador G, Villamor N, Colomo L, Martinez A, Hamoudi R, Howat WJ, Montserrat E, Campo E. High Numbers of Tumor-Infiltrating Programmed Cell Death 1–Positive Regulatory Lymphocytes Are Associated With Improved Overall Survival in Follicular Lymphoma. J Clin Oncol 2009; 27:1470-6. [DOI: 10.1200/jco.2008.18.0513] [Citation(s) in RCA: 243] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Tumor microenvironment influences the behavior of follicular lymphoma (FL), although the specific cell subsets involved are not well known. The aim of this study was to determine the impact of programmed cell death 1 (PD-1) –positive inhibitory immunoregulatory lymphoid cells in the clinicobiologic features and outcome of patients with FL. Patients and Methods We examined samples from 100 patients (53 men and 47 women; median age, 54 years) at diagnosis, as well as in 32 patients at first relapse, with a recently generated monoclonal antibody against PD-1. The cells were quantified using computerized image analysis. Additional analysis consisted of double immunofluorescence and flow cytometry. Results PD-1 expression was alternative to FOXP3 in lymphoid cells from both reactive tonsils and FL. At diagnosis, the median percentage of PD-1–positive cells was 14% (range, 0.1% to 74%). Patients with grade 3 FL, poor performance status, and high serum lactate dehydrogenase showed lower numbers of PD-1–positive cells. After a median follow-up of 6.2 years, patients with PD-1–positive cells ≤ 5% (n = 25), 6% to 33% (n = 50), and more than 33% (n = 25) had a 5-year progression-free survival rate of 20%, 46%, and 48% (P = .038) and overall survival (OS) of 50%, 77%, and 95% (P = .004), respectively. PD-1 and FL International Prognostic Index maintained prognostic value for OS in multivariate analysis. Patients with PD-1–positive cells ≤ 5% showed a higher risk of histologic transformation. At that time, transformed diffuse large B-cell lymphomas had lower percentage of PD-1–positive cells than FL. Conclusion A high content of PD-1–positive cells predicted favorable outcome of FL patients, whereas a marked reduction is observed in transformation.
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Affiliation(s)
- Joaquim Carreras
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Armando Lopez-Guillermo
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Giovanna Roncador
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Neus Villamor
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Lluis Colomo
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Antonio Martinez
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Rifat Hamoudi
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - William J. Howat
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Emili Montserrat
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Elias Campo
- From the Hematopathology Section, Departments of Pathology and Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi-Sunyer, University of Barcelona, Barcelona; Centro Nacional de Investigaciones Oncológicas, Madrid, Spain; Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge; and Histopathology/In Situ Hybridization Facility, Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, United Kingdom
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