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Margiotta-Casaluci G, Bigliardi S, Cocito F, Meli E, Petrucci L, Nicolosi M, Annibali O, Boccomini C, Bozzoli V, Castellino A, Cattina F, Cenfra N, Ciavarella S, Kovalchuk S, Rotondo F, Fama A, Olivieri J, Zaja F. Comparison of first-line treatment with bendamustine plus rituximab versus R-CHOP for patients with follicular lymphoma grade 3A: Results of a retrospective study from the Fondazione Italiana Linfomi. Front Oncol 2023; 13:1120967. [PMID: 36969038 PMCID: PMC10036382 DOI: 10.3389/fonc.2023.1120967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/06/2023] [Indexed: 03/12/2023] Open
Abstract
In the setting of follicular lymphoma (FL), frontline therapy with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) has represented for many years the standard of care for patients with symptomatic advanced disease. More recently, the combination of bendamustine plus rituximab (R-B) has emerged as an alternative therapeutic option. We present a retrospective, multicenter, observational study aimed at comparing outcomes and toxicities observed in 145 patients diagnosed with grade 3A FL treated with a first line therapy in 15 Italian Fondazione Italiana Linfomi centers between the 1st of January 2014 and the 30th of May 2018. Seventy patients were treated with R-B and 75 with R-CHOP. In the R-B group, the median age at the time of diagnosis was 67 years compared with 59 years in the R-CHOP group. Patients in R-B group achieved a similar overall response rate (96% vs. 99%) and a better complete remission rate (87% vs. 80%, p=0.035) compared with patients in R-CHOP group. Progression free survival (PFS) was similar between individual treated with R-CHOP and R-B (48- month PFS 77.7% vs. 76.6% respectively, p=0.745). The overall survival was significantly longer with R-CHOP treatment (HR=0.16; 95% IC, 0.04-0.74; p=0.007); however, no statistical significant difference was observed after adjustment for age. With the limitations of the study design, our results suggest that both R-B and R-CHOP seem to be valid first-line treatment options in FL3A.
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Affiliation(s)
- Gloria Margiotta-Casaluci
- Division of Hematology, Department of Translational Medicine, AOU Maggiore della Carità, Novara, Italy
- *Correspondence: Gloria Margiotta-Casaluci,
| | - Sara Bigliardi
- Oncology Unit, Azienda Unità Sanitaria Locale Modena, Area Sud Sede di Sassuolo, Sassuolo, Italy
| | - Federica Cocito
- Department of Hematology, San Gerardo University Hospital, Monza, Italy
| | - Erika Meli
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Luigi Petrucci
- Divisions of Hematology, Department of Translation and Precision Medicine, Policlinico Umberto I, Rome, Italy
| | - Maura Nicolosi
- Hematology Unit, Città della Salute e della Scienza, University and Hospital Torino, Torino, Italy
| | - Ombretta Annibali
- Hematology and Bone Marrow Transplant Unit, University Campus Bio-Medico, Rome, Italy
| | - Carola Boccomini
- Hematology Unit, Città della Salute e della Scienza, University and Hospital Torino, Torino, Italy
| | | | | | | | - Natalia Cenfra
- Department of Hematology, Ospedale Santa Maria Goretti, Latina, Italy
| | - Sabino Ciavarella
- Hematology Unit, Laboratory oh Hematology and Cell Therapy, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | | | | | - Angelo Fama
- Hematology Unit, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Jacopo Olivieri
- Hematology Unit, Hospital Santa Maria della Misericordia, Udine, Italy
| | - Francesco Zaja
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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2
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Zha J, Chen Q, Ye J, Yu H, Yi S, Zheng Z, Xu W, Li Z, Ping L, He X, Zhang L, Li C, Xie Y, Chen F, Sun X, Su L, Zhang H, Fan L, Lin Z, Yang H, Zhao W, Qiu L, Li Z, Song Y, Xu B. Differences in clinical characteristics and outcomes between patients with grade 3a and grades 1-2 follicular lymphoma: a real-world multicenter study. Biomark Res 2023; 11:16. [PMID: 36747226 PMCID: PMC9901161 DOI: 10.1186/s40364-023-00462-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The difference between clinical characteristics and outcomes between follicular lymphoma grade 1-2 (FL1-2) and FL3a defined pathologically remains unclear, resulting in uncertainty how to treat FL3a. However, it may be crucial for clinicians to discriminate grade 3a and grade 1-2 for predicting prognosis and thus making treatment decisions. METHODS We compared 1403 patients with FL1-2 and 765 patients with FL3a diagnosed between January 2000 and December 2020 from fifteen centers nationwide in China to describe differences in clinical characteristics and outcomes. RESULTS Compared with FL1-2 patients, FL3a subgroup had a higher percentage of elderly patients (P = 0.003), and relatively more FL3a patients presented with increased levels of LDH (P < 0.0001) and higher Ki-67 indexs greater than 30% (P < 0.001). More FL3a patients were treated with CHOP ± R (P < 0.0001), and fewer were treated with the watchful-waiting approach (P < 0.0001). The results showed a higher incidence of relapse among FL3a patients, in which more patients underwent histological transformation (HT) when compared to FL1-2 (P = 0.003). 1470 (76.2%) patients of the entire cohort received R-CHOP therapy; survival analysis revealed that FL3a patients had a worse progression-free survival (PFS) rate than FL1-2 patients. Survival of FL3a patients with respect to FLIPI showed an inferior PFS in the intermediate and high-risk groups than FL1-2 patients. FL3a patients had a much worse prognosis than FL1-2 with or without progression of disease within 24 months (POD24). FL3a patients had higher likelihood of lymphoma-related death (LRD, P < 0.05), whereas the rates for non-LRD were comparable. CONCLUSION In conclusion, this study demonstrates a marked difference in clinical features and outcomes in FL3a patients compared with FL1-2 patients. The results highlight the need for applying therapeutic approaches distinct from FL1-2 when treating FL3a patients.
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Affiliation(s)
- Jie Zha
- grid.12955.3a0000 0001 2264 7233Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, 361003 P.R China ,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Qinwei Chen
- grid.12955.3a0000 0001 2264 7233Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, 361003 P.R China ,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Jingjing Ye
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Haifeng Yu
- grid.417397.f0000 0004 1808 0985Department of Lymphoma, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China ,grid.9227.e0000000119573309Department of Lymphoma, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Shuhua Yi
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Blood Diseases Hospital & Institute of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zhong Zheng
- grid.412277.50000 0004 1760 6738Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xu
- grid.412676.00000 0004 1799 0784Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Zhifeng Li
- grid.12955.3a0000 0001 2264 7233Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, 361003 P.R China ,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Lingyan Ping
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaohua He
- grid.488530.20000 0004 1803 6191Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China ,grid.12981.330000 0001 2360 039XState Key Laboratory of Oncology in South China, Guangzhou, China ,grid.488530.20000 0004 1803 6191Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Liling Zhang
- grid.33199.310000 0004 0368 7223Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caixia Li
- grid.429222.d0000 0004 1798 0228National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Xie
- 15Shengli Clinical Medical College of Fujian Medical University, Department of Hematology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Feili Chen
- grid.413405.70000 0004 1808 0686Lymphoma Division, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiuhua Sun
- grid.452828.10000 0004 7649 7439Second Hospital of Dalian Medical University, Dalian, China
| | - Liping Su
- grid.263452.40000 0004 1798 4018Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Huilai Zhang
- grid.411918.40000 0004 1798 6427Department of Lymphoma, Tianjin Medical University Cancer Hospital, Tianjin, China
| | - Liyuan Fan
- grid.12955.3a0000 0001 2264 7233Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, 361003 P.R China ,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Zhijuan Lin
- grid.12955.3a0000 0001 2264 7233Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, 361003 P.R China ,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Haiyan Yang
- grid.417397.f0000 0004 1808 0985Department of Lymphoma, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China ,grid.9227.e0000000119573309Department of Lymphoma, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Weili Zhao
- grid.412277.50000 0004 1760 6738Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lugui Qiu
- grid.417397.f0000 0004 1808 0985Department of Lymphoma, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Zhiming Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,State Key Laboratory of Oncology in South China, Guangzhou, China. .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
| | - Bing Xu
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, 361003, P.R, China. .,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China.
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Li H, Wang M, Zhang Y, Hu F, Wang K, Wang C, Gao Z. Prediction of prognosis and pathologic grade in follicular lymphoma using 18F-FDG PET/CT. Front Oncol 2022; 12:943151. [PMID: 35965552 PMCID: PMC9366037 DOI: 10.3389/fonc.2022.943151] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigated the utility of a new baseline PET parameter expressing lesion dissemination and metabolic parameters for predicting progression-free survival (PFS) and pathologic grade in follicular lymphoma (FL). Methods The baseline 18F-FDG PET/CT images of 126 patients with grade 1–3A FL were retrospectively analyzed. A novel PET/CT parameter characterizing lesion dissemination, the distance between two lesions that were furthest apart (Dmax), was calculated. The total metabolic tumor volume and total lesion glycolysis (TLG) were computed by using 41% of the maximum standardized uptake value (SUVmax) thresholding method. Results The 5-year PFS rate was 51.9% for all patients. In the multivariate analysis, high Dmax [P = 0.046; hazard ratio (HR) = 2.877], high TLG (P = 0.004; HR = 3.612), and elevated serum lactate dehydrogenase (P = 0.041; HR = 2.287) were independent predictors of PFS. A scoring system for prognostic stratification was established based on these three adverse factors, and the patients were classified into three risk categories: low risk (zero to one factor, n = 75), intermediate risk (two adverse factors, n = 29), and high risk (three adverse factors, n = 22). Patients in the high-risk group had a shorter 3-year PFS (21.7%) than those in the low- and intermediate-risk groups (90.6 and 44.6%, respectively) (P < 0.001). The C-index of our scoring system for PFS (0.785) was superior to the predictive capability of the Follicular Lymphoma International Prognostic Index (FLIPI), FLIPI2, and PRIMA-Prognostic Index (C-index: 0.628–0.701). The receiver operating characteristic curves and decision curve analysis demonstrated that the scoring system had better differentiation and clinical utility than these existing indices. In addition, the median SUVmax was significantly higher in grade 3A (36 cases) than in grades 1 and 2 FL (90 cases) (median: 13.63 vs. 11.45, P = 0.013), but a substantial overlap existed (range: 2.25–39.62 vs. 3.17–39.80). Conclusion TLG and Dmax represent two complementary aspects of the disease, capturing the tumor burden and lesion dissemination. TLG and Dmax are promising metrics for identifying patients at a high risk of progression or relapse. Additionally, SUVmax seems to have some value for distinguishing grade 3A from low-grade FL but cannot substitute for biopsy.
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Affiliation(s)
- Hongyan Li
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Min Wang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yajing Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fan Hu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Kun Wang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chenyang Wang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Zairong Gao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Zairong Gao,
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Mekheal E, Kania BE, Roman S, Mekheal N, Kumar V, Bondili L, Maroules M. A Favorable Outcome of Grade 3 Follicular Lymphoma Treated With Surgery and Obinutuzumab Combined With Chemotherapy: A Case Report and Literature Review. Cureus 2022; 14:e23595. [PMID: 35505753 PMCID: PMC9053361 DOI: 10.7759/cureus.23595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Abstract
Follicular lymphoma is the most common type of low-grade non-Hodgkin lymphoma and the second most common type of lymphoma. Primary extranodal follicular lymphoma is rare compared with nodular follicular lymphoma involving the gastrointestinal (GI) tract. There has been uncertainty regarding follicular lymphomas due to the heterogeneous presentation and severity in which they present. However, studies showed that patients diagnosed with primary gastrointestinal follicular lymphoma do not typically differ in their presentation from those diagnosed with nodular follicular lymphoma involving the GI tract. Furthermore, recent literature identifies that patients diagnosed with grade 3 follicular lymphoma tend to have similar genetic and molecular entities to those diagnosed with diffuse large B-cell lymphoma (DLBCL). Based on these results, current studies have shown that patients with grade 3 follicular lymphoma who are treated with anthracycline-based regimens have similar outcomes to those with diffuse large B-cell lymphoma. However, additional studies are warranted to demonstrate the benefit of managing grade 3 follicular lymphoma with more aggressive anthracycline/rituximab-based regimens. Here, we present a case of a 44-year-old male diagnosed with grade 3 follicular lymphoma involving the gastrointestinal tract, who demonstrated an excellent treatment response following therapy similar to the treatment of bulky diffuse large B-cell lymphoma despite a tumor burden size below 7.5 cm.
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High-grade Follicular Lymphomas Exhibit Clinicopathologic, Cytogenetic, and Molecular Diversity Extending Beyond Grades 3A and 3B. Am J Surg Pathol 2021; 45:1324-1336. [PMID: 34334687 DOI: 10.1097/pas.0000000000001726] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although follicular lymphoma (FL) is usually graded as FL1-2, FL3A, and FL3B, some borderline cases can be observed and led us to investigate the clinicopathologic diversity of grade 3 FL (FL3). Among 2449 FL patients enrolled in Lymphoma Study Association (LYSA) trials, 1921 cases with sufficient material underwent a central pathologic review. The resulting diagnoses comprised 89.6% FL1-2 (n=1723), 7.2% FL3A (n=138), and 0.5% purely follicular FL3B (n=9). The remaining 51 unclassifiable cases (2.7%) exhibited high-grade features but did not meet WHO criteria for either FL3A or FL3B; and were considered as "unconventional" high-grade FL (FL3U). FL3U morphological pattern consisted of nodular proliferation of large cleaved cells or small-sized to medium-sized blast cells. Compared with FL3A, FL3U exhibited higher MUM1 and Ki67 expression, less BCL2 breaks and more BCL6 rearrangements, together with a higher number of cases without any BCL2, BCL6 or MYC rearrangement. FL3U harbored less frequent mutations in BCL2, KMT2D, KMT2B, and CREBBP than FL3A. MYC and BCL2 were less frequently mutated in FL3U than FL3B. Rituximab cyclophosphamide, doxorubicin, vincristine, and prednisone treated FL3U patients had a worse survival than FL1-2 patients with similar follicular lymphoma international prognostic index and treatment. These results suggest that high-grade FLs encompass a heterogeneous spectrum of tumors with variable morphology and genomic alterations, including FL3U cases that do not strictly fit WHO criteria for either FL3A or FL3B, and display a worse outcome than FL1-2. The distinction of FL3U may be useful to allow a better comprehension of high-grade FLs and to design clinical trials.
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Imber BS, Chau K, Goldberg E, Joffe E, Yahalom J. Grade 3A follicular lymphoma can be effectively controlled with very low-dose radiation therapy. Leuk Lymphoma 2020; 61:1500-1503. [PMID: 32037915 PMCID: PMC7269818 DOI: 10.1080/10428194.2020.1716222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Brandon S. Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; 1275 York Ave., New York, NY 10065
| | - Karen Chau
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; 1275 York Ave., New York, NY 10065
| | - Eliana Goldberg
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center; 1275 York Ave., New York, NY 10065
| | - Erel Joffe
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; 1275 York Ave., New York, NY 10065
| | - Joachim Yahalom
- Corresponding Author: Joachim Yahalom, MD, FACR, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, 212-639-5999,
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7
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Mercadal S, Sancho JM, Climent F, Tapia G, Pomares H, Carro I, Sorigué M, Pané M, Domingo-Doménech E, Encuentra M, Aguilera C, Oliveira AC, Andrade M, Fernández de Sevilla A, Ribera JM, González-Barca E, Sureda A. Long-term outcome comparing histological grades of follicular lymphoma patients treated with immunochemotherapy as first-line therapy: A retrospective analysis from two institutions. Eur J Haematol 2019; 104:198-206. [PMID: 31769545 DOI: 10.1111/ejh.13359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To clarify the impact of histological grades in follicular lymphoma. METHODS We retrospectively analysed 250 patients diagnosed with FL treated with chemoimmunotherapy: 188 patients were grades 1-2 and 62 grade 3A. RESULTS In our series, grade 3A FL patients were older, higher proportion of localised disease and lower bone marrow infiltration at diagnosis comparing grades 1-2 FL patients. Estimated six-year progression-free survival and time to progression showed no differences between both groups [grade 3A: 56% (95%CI: 39%-73%) and 51% (95%CI: 41%-61%) vs grades 1-2:55% (95%CI: 46%-63%) and 57% (95%CI: 49%-65%), P = .782 and P = .521, respectively]. Estimated six-year overall survival was lower, 76% (95%CI: 64%-88%) for the grade 3A group than grades 1-2 83% (95%CI: 77%-89%); P = .044. In addition to that, cumulative incidence curves of death not related to lymphoma at 10 years between groups were as follows: [0.26 (95%CI: 0.25-0.27) and 0.05 (95%CI: 0.04-0.06) for G3AFL and G1-2FL, respectively], P = .010. Grade 3A FL showed in PFS curve no relapses after 6 years. These results were absolutely reproduced in 199 patients receiving R-CHOP regimen as induction. CONCLUSIONS Our results indicate similar long-term outcomes in terms of progression-free survival and time to progression in grades 1-2 and 3A. No relapses were observed in G3AFL group after 6 years.
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Affiliation(s)
- Santiago Mercadal
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona, Spain
| | - Fina Climent
- Department of Pathology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Helena Pomares
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Itziar Carro
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Marc Sorigué
- Department of Hematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona, Spain
| | - Maria Pané
- Department of Pathology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Eva Domingo-Doménech
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Maite Encuentra
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Carmen Aguilera
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Ana Carla Oliveira
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Marcio Andrade
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Alberto Fernández de Sevilla
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Josep Maria Ribera
- Department of Hematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Institut Josep Carreras, Badalona, Spain
| | - Eva González-Barca
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Anna Sureda
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
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Multicenter Analysis of Advanced Stage Grade 3A Follicular Lymphoma Outcomes by Frontline Treatment Regimen. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:95-102. [PMID: 30581160 DOI: 10.1016/j.clml.2018.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/22/2018] [Accepted: 11/02/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Follicular lymphoma (FL) is a common form of non-Hodgkin lymphoma with a wide spectrum of presentation. While grade 1/2 FL is considered low grade and grade 3B FL is approached as an aggressive lymphoma, the management of grade 3A FL remains controversial. PATIENTS AND METHODS We performed a retrospective, multicenter analysis of patients aged ≥ 18 years with advanced stage 3/4 grade 3A FL diagnosed between January 2006 and July 2016. Patients were stratified by frontline chemotherapy regimen: anthracycline based (ATC), bendamustine (BD), and cyclophosphamide, vincristine, and prednisone (CVP). A total of 103 patients were identified from 6 contributing centers: 65 patients received ATC chemotherapy, 30 BD, and 8 CVP. The primary outcome was time to progression (TTP). Secondary outcomes included progression-free survival, overall survival, complete response rates, large cell transformation, and impact of standardized maximum uptake value on positron emission tomography/computed tomography with outcomes. Patient characteristics were similar among the 3 treatment groups. RESULTS For TTP at 24 months from initiation of treatment, 72% of ATC, 79% of BD, and 50% of CVP patients had not experienced disease progression (P = .01). Multivariate analysis demonstrated a TTP benefit for ATC compared to CVP (hazard ratio 3.22; 95% confidence interval, 1.26-8.25; P = .01) but no difference when compared to BD. Similar findings were seen with progression-free survival. While overall survival was similar among the 3 arms, there was a higher risk of large cell transformation following BD and CVP. Last, standardized maximum uptake value on positron emission tomography/computed tomography did not affect TTP when comparing BD- and ATC-treated patients. CONCLUSION Although ATC was superior to CVP, clinical outcomes (TTP, progression-free survival, and overall survival) were similar compared to BD chemotherapy for patients with grade 3A FL.
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Ying ZT, Feng HY, Mi L, Song YQ, Wang XP, Zheng W, Lin NJ, Tu MF, Xie Y, Ping LY, Zhang C, Liu WP, Deng LJ, Zhu J. [Clinical characteristics and survival analysis of de novo grade 3 or transformed follicular lymphoma patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:745-750. [PMID: 30369186 PMCID: PMC7342259 DOI: 10.3760/cma.j.issn.0253-2727.2018.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Indexed: 11/27/2022]
Abstract
Objective: To evaluate the clinical characteristics and survival outcomes of patients with de novo grade 3 or transformed follicular lymphoma (FL). Methods: Fifty-two patients treated at Peking University Cancer Hospital between January 2009 and September 2017 were assessed, including 28 patients with FL 3A grade, 13 patients with FL 3B grade, 11 patients with transformed FL. Baseline characteristics, survival and prognostic factors were analyzed. Results: ① Twenty-six male and 26 female patients were enrolled, including 28 patients with FL 3A grade, 13 patients with FL 3B grade, 11 patients with transformed FL. ②The 3-year progression-free survival (PFS) and overall survival (OS) for the entire cohort were 56.0% and 80.6%, respectively. Patients with international prognostic index (IPI) score 0-1 demonstrated significantly better 3-year PFS (80.3% vs 20.1%; t=18.902, P<0.001) and OS (95.7% vs 57.0%; t=10.406, P<0.001) than patients with IPI score 2-3. Three-year PFS (94.1% vs 37.2% vs 25.2%; P=0.002) and OS (100.0% vs 76.0% vs 59.8%; P=0.020) were also significantly different among patients with FLIPI 1 score 0-1, 2, ≥3. FLIPI 2 score was also identified as a prognostic factor for 3-year PFS (68.4%, 0, 0; P=0.001) and OS(87.5%, 76.2%, 0; P=0.003). ③Multivariate analysis indicated a significant association of PFS (HR=3.536, P=0.015) and OS (HR=15.713, P=0.015) with IPI. FLIPI 2 was associated with OS (score 0-1, HR=0.078, P=0.007; score 2, HR=0.080, P=0.022). Conclusion: De novo grade 3 or transformed FL might be a group of curable disease with current treatment strategies. IPI is still a prognostic tool in this scenario.
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Affiliation(s)
- Z T Ying
- Department of Lymphoma, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
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Rituximab Improves the Outcome of Patients With Grade 3 Follicular Lymphoma Receiving Anthracycline-Based Therapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:488-497.e2. [DOI: 10.1016/j.clml.2017.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/08/2017] [Indexed: 02/08/2023]
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Mercadal S, Pomares H, Sancho JM, Climent F, García O, Encuentra M, Domingo-Doménech E, Sorigué M, Moreno M, Oliveira AC, Ribera JM, Fernández de Sevilla A, González-Barca E. Clinico-biological features, treatment and survival of 457 patients with histological Grades 3A and 1-2 follicular lymphoma mostly treated with immunochemotherapy. Br J Haematol 2015; 172:470-3. [PMID: 26010479 DOI: 10.1111/bjh.13502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Santiago Mercadal
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Universitat de Barcelona, IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain.
| | - Helena Pomares
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Universitat de Barcelona, IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Juan M Sancho
- Department of Haematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Fina Climent
- Department of Pathology, Hospital de Bellvitge, Universitat de Barcelona, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Olga García
- Department of Haematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Maite Encuentra
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Universitat de Barcelona, IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Eva Domingo-Doménech
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Universitat de Barcelona, IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Sorigué
- Department of Haematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Miriam Moreno
- Department of Haematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Ana C Oliveira
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Universitat de Barcelona, IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Josep-Maria Ribera
- Department of Haematology, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alberto Fernández de Sevilla
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Universitat de Barcelona, IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Eva González-Barca
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Universitat de Barcelona, IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
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