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Jelicic J, Stauffer Larsen T, Bukumiric Z, Andjelic B. The clinical applicability of current prognostic models in follicular lymphoma: A systematic review. Crit Rev Oncol Hematol 2021; 164:103418. [PMID: 34246773 DOI: 10.1016/j.critrevonc.2021.103418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/18/2021] [Accepted: 07/04/2021] [Indexed: 12/29/2022] Open
Abstract
The Follicular Lymphoma International Prognostic Index (FLIPI) is widely used for risk stratification of patients with follicular lymphoma (FL). Motivated by evolvement in treatment modalities, several prognostic models for FL have been proposed recently. This systematic review aimed to identify available prognostic models for newly diagnosed FL and discuss their potential limitations. A total of ten studies fulfilled the inclusion criteria. Different clinical, laboratory, radiological, and histopathological findings were combined in prognostic models. The majority of studies developed models from clinical trial cohorts, and most lacked validation in populations treated with current treatment options. Although the FLIPI is the most widely used model for prognostication in FL patients, current prognostic models, including FLIPI, are rarely used in clinical practice for treatment decision-making. Future studies should validate the existing, or develop new prognostic models, to identify which of the current standard treatment options benefit high-risk FL patients the most.
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Affiliation(s)
- Jelena Jelicic
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Thomas Stauffer Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Zoran Bukumiric
- Department of Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bosko Andjelic
- Department of Haematology, Blackpool Victoria Hospital, Lancashire Haematology Centre, Blackpool, United Kingdom
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Li H, Wang X, Zhang L, Yi X, Qiao Y, Jin Q. Correlations between maximum standardized uptake value measured via 18F-fluorodeoxyglucose positron emission tomography/computed tomography and clinical variables and biochemical indicators in adult lymphoma. J Cancer Res Ther 2020; 15:1581-1588. [PMID: 31939441 DOI: 10.4103/jcrt.jcrt_671_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives The aim of the current study was to investigate whether the maximum standardized uptake value (SUVmax) measured by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) could discriminate between aggressive and indolent non-Hodgkin lymphomas (NHLs) and correlations between the SUVmax and clinical variables and serum biochemical indicators in adult lymphoma. Methods A total of 103 patients with lymphoma confirmed by biopsy, pretreatment 18F-FDG PET/CT scans, and a complete medical record were retrospectively enrolled in the study. Clinical variables that were evaluated included stage, pathological subtype, International Prognostic Index (IPI) score, and Ki-67 index, as well as serum biochemical indicators (e.g., lactate dehydrogenase [LDH] and erythrocyte sedimentation rate [ESR]) and metabolic parameters (e.g., SUVmax of the biopsy site on PET/CT). Correlations between SUVmax and clinical variables and serum biochemical indicators were investigated. Results Of the 103 patients, 84 had NHL and 19 had Hodgkin lymphoma. The area under the receiver operating characteristic curve for examining the accuracy of SUVmax with regard to distinguishing between aggressive and indolent NHLs was 0.94 (95% confidence interval: 0.89-0.99), suggesting that SUVmax was a useful predictor of diagnosis. A cutoff value of 8.5 yielded a sensitivity of 76.3% and specificity of 92.0%. The SUVmax mean ± standard deviation of NHL (9.8 ± 6.0, range: 1.8-28.1) was higher than that of HL (7.5 ± 2.8, range: 3.5-13.9) (P = 0.016), but there was no statistically significant difference in SUVmax between NHL and HL (P > 0.05). SUVmax of the biopsy site was strongly positively correlated with Ki-67 index (r = 0.813, P < 0.001) and moderately positively correlated with IPI score (r = 0.332, P = 0.002), but it was not significantly correlated with clinical stage, LDH, or ESR (P > 0.05). Conclusions 18F-FDG PET/CT may yield reliable measurements of tumor proliferation, and an SUVmax >8.5 may distinguish between aggressive and indolent NHLs. In adults with newly diagnosed lymphoma, SUVmax correlates with Ki-67 index and IPI score.
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Affiliation(s)
- Hongling Li
- Lanzhou University; Department of Oncology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Xiaohuan Wang
- Department of Oncology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Lingfang Zhang
- Department of Oncology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Xuemei Yi
- Department of Oncology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yujie Qiao
- Department of Oncology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qianqian Jin
- Department of Oncology, Gansu Provincial Hospital, Lanzhou, Gansu, China
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Jiménez Londoño G, García Vicente A, Poblete García V, Amo-Salas M, Calle Primo C, Ibañez García Á, Martínez Sanchís B, López-Fidalgo J, Solano Ramos F, Martínez Hellín A, Díaz Morfa M, Soriano Castrejón Á. Basal 18 F-FDG PET/CT in follicular lymphoma: A comparison of metabolic and clinical variables in the prognostic assessment. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jiménez Londoño GA, García Vicente AM, Poblete García VM, Amo-Salas M, Calle Primo C, Ibañez García Á, Martínez Sanchís B, López-Fidalgo JF, Solano Ramos F, Martínez Hellín A, Díaz Morfa M, Soriano Castrejón Á. Basal (18)F-FDG PET/CT in follicular lymphoma: A comparison of metabolic and clinical variables in the prognostic assessment. Rev Esp Med Nucl Imagen Mol 2016; 35:298-305. [PMID: 27312693 DOI: 10.1016/j.remn.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
AIM To analyze the relationship of clinical variables related to prognosis and tumor burden, with metabolic variables obtained in the staging (18)F-FDG PET/CT, and their value in the prognosis in follicular lymphoma (FL). METHODS 82 patients with FL, a (18)F-FDG PET/CT at diagnosis and a follow-up for a minimum of 12 months, were retrospectively enrolled in the present study. Clinical variables (Tumor grade, Follicular Lymphoma International Prognostic Index (FLIPI) and Tumor burden) were evaluated. Metabolic variables such as SUVmax in the highest hypermetabolic lesion, extralymphatic locations, number of involved lymph node locations, bone marrow (BM) involvement, PET stage and diameter of the biggest hypermetabolic lesion, were analyzed in order to establish a PET score and classify the studies in low, intermediate and high metabolic risk. Clinical and metabolic variables (included metabolic risk) were compared. The relation among all variables and disease-free survival (DFS) was studied. RESULTS The 28% of patients had a high-grade tumor. The 30.5% had FLIPI risk low, 29.3% intermediate y 40.2% high. The 42.7% presented a high tumor burden. The PET/CT was positive in 94% of patients. The tumor grade did not show significant relation with metabolic variable. FLIPI risk and tumor burden showed statistical relations with the SUV max and the PET score (p<0.008 and p=0.003 respectively). With respect to DFS, significant differences were detected for the PET stage and FLIPI risk (p=0.015 and p=0.047 respectively). FLIPI risk was the only significant predictor in Cox regression analysis, with a Hazard Ratio of 5.13 between high risk and low risk. CONCLUSION The present research highlights the significant relation between metabolic variables obtained with FDG PET/CT and clinical variables although their goal as an independent factor of prognosis was not demonstrated in the present work.
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Affiliation(s)
- G A Jiménez Londoño
- Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain.
| | - A M García Vicente
- Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain
| | - V M Poblete García
- Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain
| | - M Amo-Salas
- Department of Mathematics, University of Castilla La Mancha, Ciudad Real, Spain
| | - C Calle Primo
- Department of Hematology, Hospital General Universitario de Ciudad Real, Spain
| | - Á Ibañez García
- Department of Hematology, Complejo Hospitalario Universitario de Albacete, Spain
| | - B Martínez Sanchís
- Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain
| | - J F López-Fidalgo
- Department of Mathematics, University of Castilla La Mancha, Ciudad Real, Spain
| | - F Solano Ramos
- Department of Hematology, Hospital Ntra. Sra. del Prado, Talavera de la Reina, Toledo, Spain
| | - A Martínez Hellín
- Department of Hematology, Complejo Hospitalario Universitario de Albacete, Spain
| | - M Díaz Morfa
- Department of Hematology, Hospital Universitario de Guadalajara, Spain
| | - Á Soriano Castrejón
- Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Spain
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Maeng CH, Ahn SW, Ryu SY, Han S, Ko YH, Ji JH, Kim WS, Kim SJ. Treatment outcomes and clinical relevance of the Follicular Lymphoma International Prognostic Index in Korean follicular lymphoma patients treated with chemotherapy. Korean J Intern Med 2016; 31:560-9. [PMID: 26898595 PMCID: PMC4855088 DOI: 10.3904/kjim.2014.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/14/2014] [Accepted: 04/15/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/AIMS The Follicular Lymphoma International Prognostic Index (FLIPI) and FLIPI2 are well-known prognostic models for patients with follicular lymphoma (FL). However, their prognostic relevance has not been examined before in Korean patients with FL. METHODS We reviewed clinical and laboratory information from our database of patients between 1995 and 2012. In total, 125 patients were stratified in three categories according to FLIPI or FLIPI2 scores: low-, intermediate-, and high-risk groups. We compared FLIPI and FLIPI2 in terms of progression-free survival (PFS) and overall survival (OS). RESULTS Among the 125 patients, the prognostic value of FLIPI and FLIPI2 was evaluated in 73 patients who fulfilled the criteria of both prognostic models. Risk stratification by FLIPI and FLIPI2 showed significant differences in unfavorable parameters among each risk group, particularly between low- and intermediate-risk groups. The high-risk group b was significantly associated with poor PFS on both FLIPI and FLIPI2 (p < 0.05). However, the OS was significantly different only in the risk groups determined by FLIPI2 (p = 0.042). In a subgroup analysis of patients who received rituximab-containing chemotherapy, the risk stratification of both prognostic models showed a significant impact on PFS, especially in the low-risk group. CONCLUSIONS FLIPI and FLIPI2 are appropriate prognostic models in Korean FL patients, especially for discriminating low-risk patients from intermediate- and high-risk groups.
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Affiliation(s)
- Chi Hoon Maeng
- Division of Hematology and Oncology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Woo Ahn
- Department of Education and Training, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong-Yoon Ryu
- Department of Education and Training, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sungjun Han
- Department of Education and Training, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Ji
- Division of Hematology and Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Won Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Seok Jin Kim, M.D. Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-1766 Fax: +82-2-3410-1754
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Mounier M, Bossard N, Belot A, Remontet L, Iwaz J, Dandoit M, Girard-Boulanger S, Herry A, Woronoff AS, Casasnovas RO, Maynadié M, Giorgi R. Trends in excess mortality in follicular lymphoma at a population level. Eur J Haematol 2014; 94:120-9. [PMID: 24952984 DOI: 10.1111/ejh.12403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since the 1990s and since the development of humanised monoclonal antibodies in 1998, the treatment of non-Hodgkin lymphoma has undergone profound changes. Follicular lymphoma (FL) was the first to benefit from this treatment, and several clinical trials have shown a significant improvement in overall survival, but little information is available at a population level. OBJECTIVE Our objective was to estimate changes in FL-specific mortality at a population level, with an appropriate methodology. METHODS Two French retrospective population-based studies on FL were conducted, one from 1995 to 2004, in 1477 patients, and one from 1995 to 2010, in 451 patients. Trends in excess mortality rates (EMRs) according to age, sex, Ann Arbor stage and year of diagnosis were evaluated using the flexible model of Remontet et al. RESULTS Trends in the EMR differed according to age at diagnosis and was higher in advanced stage (III, IV) in patients older than 65 yr. The EMR decreased linearly from 1995 to 2010. This decrease was more marked for advanced stages. CONCLUSION FL-specific mortality decreased over the years of diagnosis, and the difference according to the lymphoma stage diminished in more recent years. However, progress in the management of FL was not able to erase age-related differences.
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Affiliation(s)
- Morgane Mounier
- Registre des Hémopathies Malignes de Côte d'Or, EA 4184, Université de Bourgogne, Dijon, France
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Cancer in the elderly: is it time for palliative care in geriatric oncology? J Geriatr Oncol 2014; 5:197-203. [PMID: 24560041 DOI: 10.1016/j.jgo.2014.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/26/2013] [Accepted: 01/28/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Persons aged 65 and over are the fastest growing segment of the population in most Western countries. Although cancer-related death occurs far more commonly in older people than in any age group, studies on palliative care in older adults are lacking. OBJECTIVE This paper aims at evaluating the needs in elderly patients affected by cancer and the state of the art of the research in palliative care in this setting. MATERIALS AND METHODS A literature search was performed (PubMed) to identify relevant studies. Papers were reviewed for relevance to palliative care in the elderly. RESULTS Elderly who need palliative care are frequently disregarded as individuals and may experience discrimination because of their age. Palliative care for older patients relates particularly to multiple treatments for various conditions. This causes extra complexities for the researchers. CONCLUSIONS The aim of the study was not fully achieved due to the paucity of literature focusing upon these issues. The areas of investigation that need to be addressed comprise: establishing the prevailing symptoms in elderly patients, understanding patients' psychological/spiritual well-being and quality of life and elucidating the sources of caregiver burden, adapting research methodologies specifically for palliative care and comparing the needs and the outcomes of this age group to younger patients.
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Zinzani PL, Khuageva NK, Wang H, Garicochea B, Walewski J, Van Hoof A, Soubeyran P, Caballero D, Buckstein R, Esseltine DL, Theocharous P, Enny C, Zhu E, Elsayed YA, Coiffier B. Bortezomib plus rituximab versus rituximab in patients with high-risk, relapsed, rituximab-naïve or rituximab-sensitive follicular lymphoma: subgroup analysis of a randomized phase 3 trial. J Hematol Oncol 2012; 5:67. [PMID: 23088650 PMCID: PMC3502148 DOI: 10.1186/1756-8722-5-67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/18/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The randomized phase 3 LYM3001 trial in relapsed follicular lymphoma (FL) demonstrated higher overall (ORR) and complete response (CR) rates and prolonged progression-free survival (PFS) with bortezomib-rituximab versus rituximab. We report findings in high-risk patients (FL International Prognostic Index [FLIPI] score ≥3, and high tumor burden by modified Groupe d'Etude des Lymphomas Folliculaires [GELF] criteria). METHODS Patients aged ≥18 years with grade 1/2 FL, ≥1 measurable lesion, and documented relapse or progression following prior therapy, rituximab-naïve or rituximab-sensitive, were enrolled at 164 centers in 29 countries across Europe, the Americas, and Asia-Pacific. Patients were randomized (1:1) to five 5-week cycles of bortezomib-rituximab (bortezomib 1.6 mg/m2, days 1, 8, 15, and 22, all cycles; rituximab 375 mg/m2, days 1, 8, 15, and 22, cycle 1, and day 1, cycles 2-5; N=336) or rituximab alone (N=340). Randomization was stratified by FLIPI score, prior rituximab, time since last dose of anti-lymphoma therapy, and geographical region. The primary endpoint of the study was PFS. RESULTS 103 bortezomib-rituximab and 98 rituximab patients had high-risk FL. The ORR was 59% versus 37% (p=0.002), the CR/CRu rate was 13% versus 6% (p=0.145), and the durable response rate was 45% versus 26% (p=0.008) with bortezomib-rituximab versus rituximab. Median PFS was 9.5 versus 6.7 months (hazard ratio [HR] 0.667, p=0.012) with bortezomib-rituximab versus rituximab; median time to progression was 10.9 versus 6.8 months (HR 0.656, p=0.009); median time to next anti-lymphoma treatment was 14.8 versus 9.1 months (HR 0.762, p=0.103); and the 1-year Overall Survival rate was 83.1% versus 76.6%. Overall, 51% of bortezomib-rituximab and 32% of rituximab patients reported grade ≥3 adverse events, including neutropenia (18%, 6%), anemia (4%, 5%), diarrhea (8%, 0%), thrombocytopenia (5%, 2%), and sensory neuropathy (1%, 0%). CONCLUSIONS High-risk FL patients treated with bortezomib-rituximab had significantly higher ORR and longer PFS than patients receiving rituximab alone, with greater clinical benefit than in the overall study population; additional toxicity was acceptable and did not affect treatment feasibility. TRIAL REGISTRATION The phase 3 LYM3001 trial is registered with ClinicalTrials.gov, with the identifier NCT00312845.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Boronic Acids/administration & dosage
- Boronic Acids/adverse effects
- Bortezomib
- Disease-Free Survival
- Drug Resistance, Neoplasm
- Female
- Humans
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Pyrazines/administration & dosage
- Pyrazines/adverse effects
- Rituximab
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Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology ‘L. & A. Seràgnoli’, University of Bologna, Bologna, Italy
| | | | - Huaqing Wang
- Medical Oncology, Medical University Cancer Hospital, Tianjin, China
| | | | - Jan Walewski
- Hematology, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | | | | | - Dolores Caballero
- Clinical Hematology, Hospital Clínico de Salamanca, Salamanca, Spain
| | - Rena Buckstein
- Medical Oncology & Hematology, Sunnybrook Regional Cancer Center, Toronto, Canada
| | | | | | | | - Eugene Zhu
- Oncology R&D, Janssen R&D, Raritan, NJ, USA
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Arcaini L, Rattotti S, Gotti M, Luminari S. Prognostic assessment in patients with indolent B-cell lymphomas. ScientificWorldJournal 2012; 2012:107892. [PMID: 22919288 PMCID: PMC3417199 DOI: 10.1100/2012/107892] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 06/03/2012] [Indexed: 01/15/2023] Open
Abstract
Follicular lymphoma (FL) is an indolent lymphoma with long median survival. Many studies have been performed to build up prognostic scores potentially useful to identify patients with poorer outcome. In 2004, an international consortium coordinated by the International Follicular Lymphoma Prognostic Factor project was established and a new prognostic study was launched (FLIPI2) using progression-free survival (PFS) as main endpoint and integrating all the modern parameters prospectively collected. Low-grade non-Hodgkin lymphomas were once considered as a heterogenous group of lymphomas characterized by an indolent clinical course. Each entity is characterized by unique clinicobiologic features. Some studies have been focused on prognostic factors in single lymphoma subtypes, with the development of specific-entity scores based on retrospective series, for instance splenic marginal zone lymphoma (SMZL). A widely accepted prognostic tool for clinical usage for indolent non-follicular B-cell lymphomas is largely awaited. In this paper we summarized the current evidence regarding prognostic assessment of indolent follicular and non-follicular lymphomas.
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Affiliation(s)
- Luca Arcaini
- Division of Hematology, Department of Hematology and Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy.
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Younes SF, Beck AH, Ohgami RS, Lossos IS, Levy R, Warnke RA, Natkunam Y. The efficacy of HGAL and LMO2 in the separation of lymphomas derived from small B cells in nodal and extranodal sites, including the bone marrow. Am J Clin Pathol 2011; 135:697-708. [PMID: 21502424 DOI: 10.1309/ajcp7z2bibunqplz] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We studied the efficacy of 2 germinal center B-cell markers, HGAL and LMO2, in the separation of lymphomas derived from small B cells, particularly follicular lymphoma (FL) and marginal zone lymphoma occurring in nodal, extranodal, splenic, and bone marrow sites using immunohistochemical analysis for CD10, BCL6, BCL2, HGAL, and LMO2. Our results showed that HGAL and LMO2 are sensitive and specific markers for detecting FL in nodal and extranodal sites. In contrast, all markers were down-regulated in FL infiltrates in the bone marrow. CD10 and HGAL were expressed in a subset of FLs in the bone marrow and were highly correlated with each other and with CD21, a marker of follicular dendritic cells. We conclude that HGAL and LMO2 should be considered in immunohistochemical panels used for the routine workup of lymphomas derived from small B cells. In the bone marrow, staining for HGAL or CD10 can be helpful in making a diagnosis of FL, although they are absent in a subset of cases.
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Follicular lymphoma prognostic factors in the modern era: what is clinically meaningful? Int J Hematol 2010; 92:246-54. [PMID: 20803352 DOI: 10.1007/s12185-010-0674-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 08/19/2010] [Indexed: 01/08/2023]
Abstract
Follicular lymphomas (FL) account for 30% of non-Hodgkin's lymphomas (NHL). Their evolution is heterogeneous. Some patients present with indolent forms undergoing several relapses while in other patients the disease evolves abruptly toward aggressive NHL. This is why accurate prognostic indices are required so that treatment strategies may be optimized for each patient and so that trials may be conducted in groups of patients that are as homogeneous as possible. The Follicular Lymphoma International Prognostic Index (FLIPI) has been designed to separate patients into 3 groups with significantly different hazard ratios for death. Its accuracy has been confirmed in several studies. The FLIPI2 was designed more recently to separate patients with significantly different hazard ratios for progression/relapse in the era of anti-CD20 monoclonal antibody treatments. Gene profile studies have shown that the prognosis of FL is mainly related to the type, number, and activation of immune cells in the microenvironment of lymphomatous follicles. Immunohistochemical studies suggest that macrophages, CD4+ T cells and among them T-regulatory cells (T-regs) and programed death-1 cells (PD-1 cells) play a major role in the outcome of FLs. However, additional confirmatory studies are required due to discrepancies in results. Up to now, these biological study results are more useful for approaching the pathophysiology of FL rather than to be used as prognostic tools in clinical practice.
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