A significant diffuse component predicts for inferior survival in grade 3 follicular lymphoma, but cytologic subtypes do not predict survival

Christine P. Hans, Dennis D. Weisenburger, Julie Marie Vose, Lynette M Smith, James C. Lynch, Patricia Aoun, Timothy Charles Greiner, Wing C. Chan, Robert G Bociek, Philip Jay Bierman, James Olen Armitage

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Grade 3 follicular lymphoma (FL3) is thought to have an aggressive clinical course. On the basis of possible biologic differences, the new World Health Organization (WHO) classification of lymphoma suggests further subdivision of FL3 into grades 3a and 3b and states that the percentage of involvement by diffuse large B-cell lymphoma (DLBCL) should also be reported. However, the clinical implications of these features are unclear. Therefore, we studied 190 newly diagnosed patients with lymph node-based FL3 who received anthracycline-containing combination chemotherapy. The follicular component was subclassified as grade 3a (FL3a) or grade 3b (FL3b) according to the WHO criteria, or as follicular large cleaved cell type (FLC). The percentage of a diffuse component, if present, was also recorded. Of the 190 cases, there were 107 FL3a (56%), 53 FL3b (28%), and 30 FLC (16%) cases. Diffuse areas were seen in 72 cases (31 FL3a, 28 FL3b, and 13 FLC). There were no significant differences in the clinical characteristics, overall survival, or event-free survival between patients with grades FL3a, FL3b, or FLC. However, those cases with a predominant diffuse component (> 50% diffuse) had a significantly worse overall survival (P = .0037) and event-free survival (P = .012). Therefore, we conclude that the subdivision of FL3 into cytologic subtypes does not appear to be important clinically. However, patients with FL3 having a diffuse component of more than 50% have an inferior survival that is similar to the survival of those with DLBCL.

Original languageEnglish (US)
Pages (from-to)2363-2367
Number of pages5
JournalBlood
Volume101
Issue number6
DOIs
StatePublished - Mar 15 2003

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Follicular Lymphoma
Health
Chemotherapy
Survival
Lymphoma, Large B-Cell, Diffuse
Anthracyclines
Disease-Free Survival
Cells
Combination Drug Therapy
Lymphoma
Lymph Nodes

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

A significant diffuse component predicts for inferior survival in grade 3 follicular lymphoma, but cytologic subtypes do not predict survival. / Hans, Christine P.; Weisenburger, Dennis D.; Vose, Julie Marie; Smith, Lynette M; Lynch, James C.; Aoun, Patricia; Greiner, Timothy Charles; Chan, Wing C.; Bociek, Robert G; Bierman, Philip Jay; Armitage, James Olen.

In: Blood, Vol. 101, No. 6, 15.03.2003, p. 2363-2367.

Research output: Contribution to journalArticle

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abstract = "Grade 3 follicular lymphoma (FL3) is thought to have an aggressive clinical course. On the basis of possible biologic differences, the new World Health Organization (WHO) classification of lymphoma suggests further subdivision of FL3 into grades 3a and 3b and states that the percentage of involvement by diffuse large B-cell lymphoma (DLBCL) should also be reported. However, the clinical implications of these features are unclear. Therefore, we studied 190 newly diagnosed patients with lymph node-based FL3 who received anthracycline-containing combination chemotherapy. The follicular component was subclassified as grade 3a (FL3a) or grade 3b (FL3b) according to the WHO criteria, or as follicular large cleaved cell type (FLC). The percentage of a diffuse component, if present, was also recorded. Of the 190 cases, there were 107 FL3a (56{\%}), 53 FL3b (28{\%}), and 30 FLC (16{\%}) cases. Diffuse areas were seen in 72 cases (31 FL3a, 28 FL3b, and 13 FLC). There were no significant differences in the clinical characteristics, overall survival, or event-free survival between patients with grades FL3a, FL3b, or FLC. However, those cases with a predominant diffuse component (> 50{\%} diffuse) had a significantly worse overall survival (P = .0037) and event-free survival (P = .012). Therefore, we conclude that the subdivision of FL3 into cytologic subtypes does not appear to be important clinically. However, patients with FL3 having a diffuse component of more than 50{\%} have an inferior survival that is similar to the survival of those with DLBCL.",
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AU - Smith, Lynette M

AU - Lynch, James C.

AU - Aoun, Patricia

AU - Greiner, Timothy Charles

AU - Chan, Wing C.

AU - Bociek, Robert G

AU - Bierman, Philip Jay

AU - Armitage, James Olen

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N2 - Grade 3 follicular lymphoma (FL3) is thought to have an aggressive clinical course. On the basis of possible biologic differences, the new World Health Organization (WHO) classification of lymphoma suggests further subdivision of FL3 into grades 3a and 3b and states that the percentage of involvement by diffuse large B-cell lymphoma (DLBCL) should also be reported. However, the clinical implications of these features are unclear. Therefore, we studied 190 newly diagnosed patients with lymph node-based FL3 who received anthracycline-containing combination chemotherapy. The follicular component was subclassified as grade 3a (FL3a) or grade 3b (FL3b) according to the WHO criteria, or as follicular large cleaved cell type (FLC). The percentage of a diffuse component, if present, was also recorded. Of the 190 cases, there were 107 FL3a (56%), 53 FL3b (28%), and 30 FLC (16%) cases. Diffuse areas were seen in 72 cases (31 FL3a, 28 FL3b, and 13 FLC). There were no significant differences in the clinical characteristics, overall survival, or event-free survival between patients with grades FL3a, FL3b, or FLC. However, those cases with a predominant diffuse component (> 50% diffuse) had a significantly worse overall survival (P = .0037) and event-free survival (P = .012). Therefore, we conclude that the subdivision of FL3 into cytologic subtypes does not appear to be important clinically. However, patients with FL3 having a diffuse component of more than 50% have an inferior survival that is similar to the survival of those with DLBCL.

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