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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: 0] [Impact Index Per Article: 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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2
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Barraclough A, Bishton M, Cheah CY, Villa D, Hawkes EA. The diagnostic and therapeutic challenges of Grade 3B follicular lymphoma. Br J Haematol 2021; 195:15-24. [PMID: 33704790 DOI: 10.1111/bjh.17404] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Grade 3B follicular lymphoma (G3B FL) is rare, accounting for only 5-10% of FLs. Not only has it been routinely excluded from clinical trials, but data published on diagnosis, outcomes, choice of therapies and role of imaging are conflicting. With the advent of increasingly diverse treatment options for low-grade (G1-3A) FL, and the molecular subcategorisation of high-grade B-cell lymphomas, characterisation and treatment of G3B FL is ever more important as extrapolation of data becomes more difficult. New data have emerged exploring unique genetic characteristics, specific features on positron emission tomography imaging, choice of therapy, and outcomes of G3B FL in the current era. The present review will summarise and appraise these new data, and offer recommendations based on current evidence.
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Affiliation(s)
- Allison Barraclough
- Department of Haematology, Austin Health, Melbourne, Vic., Australia.,Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Mark Bishton
- Department of Haematology, Nottingham City Hospital, Nottingham, UK
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Medical School, University of Western Australia, Perth, WA, Australia
| | - Diego Villa
- Centre for Lymphoid Cancer, British Columbia Cancer and University of British Columbia, Vancouver, BC, Canada
| | - Eliza A Hawkes
- Department of Medical Oncology and Haematology, Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne, Vic., Australia.,Department of Medical Oncology and Haematology, Eastern Health, Melbourne, Vic., Australia
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3
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Mondello P, Steiner N, Willenbacher W, Cerchione C, Nappi D, Mauro E, Ferrero S, Cuzzocrea S, Mian M. Bendamustine plus Rituximab Versus R-CHOP as First-Line Treatment for Patients with Follicular Lymphoma Grade 3A: Evidence from a Multicenter, Retrospective Study. Oncologist 2018; 23:454-460. [PMID: 29317554 DOI: 10.1634/theoncologist.2017-0037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 11/10/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Rituximab plus bendamustine (R-B) has been demonstrated to improve outcomes and reduce toxicity compared with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) in follicular lymphoma (FL). Nevertheless, in clinical practice, many centers still prefer R-CHOP to R-B in patients with FL grade 3A (FL3A). Therefore, we retrospectively assessed patients with FL3A treated with either R-CHOP or R-B in five European cancer centers and compared their outcomes. MATERIALS AND METHODS We retrospectively assessed 132 patients affected by FL grade 3A treated with either R-B or R-CHOP in the first line and evaluated outcome and toxicity according to the type of treatment. This study included 101 patients who were a subgroup of a previously published cohort. RESULTS R-B was less toxic and achieved a similar percentage of complete remissions compared with R-CHOP (97% vs. 96%, p = .3). During follow-up, 10 (16%) patients relapsed after R-B and 29 (41%) after R-CHOP (p = .001), leading to a median progression-free survival (PFS) of 15 versus 11.7 years, respectively (p = .03). Furthermore, R-B overcame the negative prognostic impact of BCL2 expression (15 vs. 4.8 years; p = .001). However, median overall survival was similar between both groups (not reached for both; p = .8). CONCLUSION R-B as a first-line treatment of FL3A is better tolerated than R-CHOP and seems to induce more profound responses, leading to a significantly lower relapse rate and prolonged PFS. Therefore, R-B is a valid treatment option for FL grade 3A. IMPLICATIONS FOR PRACTICE Rituximab plus bendamustine (R-B) has shown to be less toxic and more effective than rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) in follicular lymphoma grade 3A. Although both regimens can induce a complete remission in >95% of patients, relapses occur more frequently after R-CHOP than R-B, leading to a significantly longer progression-free survival in the latter. R-B is also able to overcome the impact of negative prognosticators, such as BCL2 expression. However, because of the indolent course of this disease and efficient salvage treatments, overall survival was similar in both treatment groups. Therefore, R-B is a valid treatment option in this patient setting.
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Affiliation(s)
- Patrizia Mondello
- Department of Human Pathology, University of Messina, Messina, Italy
- Department of Biological and Environmental Sciences, University of Messina, Messina, Italy
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, USA
| | - Normann Steiner
- Internal Medicine V: Hematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Internal Medicine V: Hematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudio Cerchione
- Haematology Division, "Federico II" University Hospital, Naples, Italy
| | - Davide Nappi
- Haematology Division, "Federico II" University Hospital, Naples, Italy
| | - Endri Mauro
- Department of Internal Medicine, Pordenone General Hospital, Pordenone, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology AOU "Città della Salute e della Scienza di Torino,", Turin, Italy
| | - Salvatore Cuzzocrea
- Department of Biological and Environmental Sciences, University of Messina, Messina, Italy
| | - Michael Mian
- Haematology Division, "Federico II" University Hospital, Naples, Italy
- Department of Hematology & CBMT, Ospedale di Bolzano, Bolzano, Italy
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4
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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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5
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Jaiswal M, Gandhi A, Purohit D, Singhvi S, Mittal RS. Primary non-Hodgkin's lymphoma of the skull with extra and intracranial extension presenting with bulky scalp mass lesion. Asian J Neurosurg 2016; 11:444. [PMID: 27695553 PMCID: PMC4974974 DOI: 10.4103/1793-5482.145093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary non-Hodgkin's lymphoma (NHL) of the cranium with extra- and intracranial extension without systemic or skeletal manifestation in a non-immunocompromised patient is extremely rare. These lesions are most of the time misdiagnosed because they mimic other conditions like meningioma. Here, we report a case presented with huge bulky scalp mass which on magnetic resonance imaging (MRI) brain showed involvement of scalp, cranial vault, meninges, and the brain parenchyma, mimicking a meningioma. After gross total resection, biopsy and CD marker study revealed primary non-Hodgkin's diffuse large B-cell lymphoma (DLBCL). Malignant NHL should be considered in differential diagnosis of bulky scalp mass lesion.
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Affiliation(s)
- Manish Jaiswal
- Department of Neurosurgery, SMS Medical College and Hospital, JLN Marg, Jaipur, Rajasthan, India
| | - Ashok Gandhi
- Department of Neurosurgery, SMS Medical College and Hospital, JLN Marg, Jaipur, Rajasthan, India
| | - Devendra Purohit
- Department of Neurosurgery, SMS Medical College and Hospital, JLN Marg, Jaipur, Rajasthan, India
| | - Shashi Singhvi
- Department of Neurosurgery, SMS Medical College and Hospital, JLN Marg, Jaipur, Rajasthan, India
| | - Radhey Shyam Mittal
- Department of Neurosurgery, SMS Medical College and Hospital, JLN Marg, Jaipur, Rajasthan, India
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6
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Is watch and wait still acceptable for patients with low-grade follicular lymphoma? Blood 2016; 127:2804-8. [PMID: 26994147 DOI: 10.1182/blood-2015-11-632745] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/06/2016] [Indexed: 02/07/2023] Open
Abstract
Follicular lymphoma (FL) represents more than 20% of all non-Hodgkin lymphomas worldwide and approximately 30% of the non-Hodgkin lymphomas diagnosed in the United States. Although occasionally localized at the time of diagnosis, most patients have disseminated disease. However, patients are frequently asymptomatic, and this, in combination with a long median survival, led to the initial studies of observing asymptomatic patients without initial therapy, ie, "watch and wait." Since the initial report of watch and wait as a treatment strategy for patients with low-grade FL, our understanding of the biology of the disease has advanced; multiple active new agents have been introduced into practice, and the survival of patients with low-grade FL has improved. Given these changes, is watch and wait still an acceptable treatment recommendation for a newly diagnosed patient with low-grade FL?
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7
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Yamamoto E, Tomita N, Sakata S, Tsuyama N, Takeuchi K, Nakajima Y, Miyashita K, Tachibana T, Takasaki H, Tanaka M, Hashimoto C, Koharazawa H, Fujimaki K, Taguchi J, Harano H, Motomura S, Ishigatsubo Y. MIB-1 labeling index as a prognostic factor for patients with follicular lymphoma treated with rituximab plus CHOP therapy. Cancer Sci 2013; 104:1670-4. [PMID: 24112697 DOI: 10.1111/cas.12288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/28/2013] [Accepted: 09/06/2013] [Indexed: 11/29/2022] Open
Abstract
The MIB-1 labeling index, which is based on Ki67 immunostaining, is widely used to evaluate the proliferation of tumor cells in lymphoma. However, its clinical significance has not been fully assessed. We retrospectively evaluated the prognostic impact of the MIB-1 labeling index at the time of diagnosis, in 98 patients with follicular lymphoma (FL) grade 1-3b who were treated uniformly with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) therapy. The 5-year progression-free survival (PFS) for an MIB-1 labeling index of ≥10% (n = 60) and <10% (n = 38) was 35% and 61%, respectively (P = 0.015). The 5-year overall survival (OS) for an MIB-1 labeling index of ≥10% and <10% was 77% and 92%, respectively (P = 0.025). Pathological grading was not correlated with PFS or OS. In multivariate analysis, an MIB-1 labeling index of ≥10% was independently associated with poor PFS and OS. In conclusion, an MIB-1 labeling index of 10% is a useful cut-off level for predicting the prognosis of patients with FL.
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Affiliation(s)
- Eri Yamamoto
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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8
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Itchaki G, Gafter-Gvili A, Lahav M, Vidal L, Raanani P, Shpilberg O, Paul M. Anthracycline-containing regimens for treatment of follicular lymphoma in adults. Cochrane Database Syst Rev 2013:CD008909. [PMID: 23832787 DOI: 10.1002/14651858.cd008909.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anthracycline-containing regimens (ACR) are the most prevalent regimens in the management of patients with advanced follicular lymphoma (FL). However, there is no proof that they are superior to non-anthracycline-containing regimens (non-ACR). OBJECTIVES To compare the efficacy of ACRs to other chemotherapy regimens, in the treatment of FL. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 3), MEDLINE (January 1966 to April 2013), smaller databases, relevant conference proceedings (2004 to 2012) and the National Medical Library (April 2013). SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing ACR with non-ACR for adult patients with FL. We excluded trials in which immunotherapy, radiotherapy alone or stem-cell transplantation were used in one arm alone. Our primary outcome was overall survival (OS). Secondary outcomes included disease control, as measured by progression-free survival (PFS) or remission duration (RD). DATA COLLECTION AND ANALYSIS Two review authors assessed the quality of trials and extracted data. We contacted study authors for additional information. We analyzed trials separately according to resemblance of the chemotherapeutic regimens in study arms, other than the addition of anthracyclines ('same' versus 'different' chemotherapy). Hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI) were estimated and pooled using the fixed-effect model. MAIN RESULTS Eight RCTs, conducted between 1974 and 2011, and involving 2636 patients were included in this meta-analysis. All trials included therapy-naive patients. Rituximab was used in one trial only. Follow-up was between three and five years in most trials (range three to 18 years). All trials were published in peer-reviewed journals.Five trials compared similar chemotherapeutic regimens, except for the anthracycline. In three studies reporting overall survival specifically in FL patients, there was no statistically significant difference between ACR and non-ACR arms (HR 0.99; 95% CI 0.77 to 1.29; I(2) = 0%). ACR significantly improved disease control (HR 0.65; 95% CI 0.52 to 0.81; four trials). Progression or relapse at three years were reduced (RR 0.73; 95% CI 0.63 to 0.85). Anthracyclines did not significantly increase rates of complete response (RR 1.05; 95% CI 0.94 to 1.18) or overall response (RR 1.06; 95% CI 1.00 to 1.12), but heterogeneity was substantial.Overall, ACR were more often associated with cytopenias, but not with serious infections or death related to chemotherapy. Cardiotoxicity, albeit rare, was associated with anthracycline use (RR 4.55; 95% CI 0.92 to 22.49; four trials).Three trials added anthracycline to one arm of two different regimens. None showed benefit to ACR regarding OS, yet there was a trend in favor of anthracyclines for disease control. Results were heterogeneous.We judged the overall quality of these trials as moderate as all are unblinded, some are outdated and are not uniform in outcome definitions. AUTHORS' CONCLUSIONS The use of anthracyclines in patients with FL has no demonstrable benefit on overall survival, although it may have been mitigated by the more intense regimens given in the control arms of three of five trials. ACR improved disease control, as measured by PFS and RD with an increased risk for side effects, notably cardiotoxicity. The current evidence on the added value of ACR in the management of FL is limited. Further studies involving immunotherapy during induction and maintenance may change conclusion.
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Affiliation(s)
- Gilad Itchaki
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel. .
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9
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Oral lenalidomide with rituximab in relapsed or refractory diffuse large cell, follicular and transformed lymphoma: a phase II clinical trial. Leukemia 2013; 27:1902-9. [DOI: 10.1038/leu.2013.95] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/12/2013] [Indexed: 01/13/2023]
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Wahlin BE, Yri OE, Kimby E, Holte H, Delabie J, Smeland EB, Sundström C, Christensson B, Sander B. Clinical significance of the WHO grades of follicular lymphoma in a population-based cohort of 505 patients with long follow-up times. Br J Haematol 2011; 156:225-33. [DOI: 10.1111/j.1365-2141.2011.08942.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Shustik J, Quinn M, Connors J, Gascoyne R, Skinnider B, Sehn L. Follicular non-Hodgkin lymphoma grades 3A and 3B have a similar outcome and appear incurable with anthracycline-based therapy. Ann Oncol 2011; 22:1164-1169. [DOI: 10.1093/annonc/mdq574] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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13
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Relander T, Johnson NA, Farinha P, Connors JM, Sehn LH, Gascoyne RD. Prognostic Factors in Follicular Lymphoma. J Clin Oncol 2010; 28:2902-13. [DOI: 10.1200/jco.2009.26.1693] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Follicular lymphoma (FL) is one of the most common types of non-Hodgkin's lymphoma. It is usually diagnosed at an advanced stage, for which many treatment options exist, however, no curative standard therapy has been identified. The outcome is highly variable with a median survival of approximately 10 years. The life expectancy of patients with FL has been extended with the use of rituximab, a monoclonal antibody targeting the CD20 antigen on FL cells, but there remains a group of patients who fail to respond to chemoimmunotherapy and die early of their disease. Transformation of FL to an aggressive histology is an important event with high morbidity and mortality. The Follicular Lymphoma International Prognostic Index has become the clinically useful prognostic tool, but gives only a rough estimate of expected outcome. There is a need for useful biomarkers for prediction of the disease course of single patients to individualize therapy, especially in the new era of chemoimmunotherapy.
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Affiliation(s)
- Thomas Relander
- From the Departments of Pathology & Laboratory Medicine and the Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathalie A. Johnson
- From the Departments of Pathology & Laboratory Medicine and the Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Pedro Farinha
- From the Departments of Pathology & Laboratory Medicine and the Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph M. Connors
- From the Departments of Pathology & Laboratory Medicine and the Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie H. Sehn
- From the Departments of Pathology & Laboratory Medicine and the Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Randy D. Gascoyne
- From the Departments of Pathology & Laboratory Medicine and the Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada
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14
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Buske C, Gisselbrecht C, Gribben J, Letai T, Mclaughlin P, Wilson W. Refining the treatment of follicular lymphoma. Leuk Lymphoma 2009; 49 Suppl 1:18-26. [DOI: 10.1080/10428190802311409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Emmanouilides C. Current treatment options in follicular lymphoma: Science and bias. Leuk Lymphoma 2009; 48:2098-109. [DOI: 10.1080/10428190701606867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Christie L, Kernohan N, Levison D, Sales M, Cunningham J, Gillespie K, Batstone P, Meiklejohn D, Goodlad J. C-MYCtranslocation in t(14;18) positive follicular lymphoma at presentation: An adverse prognostic indicator? Leuk Lymphoma 2009; 49:470-6. [DOI: 10.1080/10428190701836845] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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McLaughlin P. Follicular lymphoma: the case for timely intervention. Expert Rev Hematol 2009; 2:277-84. [PMID: 21082969 DOI: 10.1586/ehm.09.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
After decades of slow progress in the management of follicular lymphoma (FL), important strides are occurring. An aim for cure is realistic and appropriate for some patients, including those with stage I-II disease, some histologic subtypes of FL (e.g., FL grade 3b) and even some relapsing patients following allogeneic stem cell transplantation approaches. Survival outcomes are improving, probably in large part related to the inclusion of anti-CD20 monoclonal antibodies in current treatment strategies.
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Affiliation(s)
- Peter McLaughlin
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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18
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Yoon SH, Paek SH, Park SH, Kim DG, Jung HW. Non-Hodgkin lymphoma of the cranial vault with retrobulbar metastasis mimicking a subacute subdural hematoma. J Neurosurg 2008; 108:1018-20. [DOI: 10.3171/jns/2008/108/5/1018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓Primary skeletal non-Hodgkin lymphoma is rare. The authors report a case of a small lymphocytic B-cell lymphoma of the skull occurring in a 53-year-old man who presented with right-hand apraxia. Initial computed tomography and magnetic resonance imaging revealed a hematoma-mimicking lesion in the left frontoparietal subdural area. A frontotemporoparietal craniectomy and biopsy procedure yielded a diagnosis of small lymphocytic B-cell lymphoma, with a metastatic nodule in the retrobulbar area. Three years after undergoing radiation therapy and surgery, the patient has shown neurological improvement without systemic dissemination of the malignancy. The lesion in this case was misdiagnosed as a subdural hematoma, and shows the importance of including lymphoma in the differential diagnosis of subdural mass lesions.
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Affiliation(s)
| | | | - Sung-Hye Park
- 2Pathology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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19
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Overman M, Feng L, Pro B, McLaughlin P, Hess M, Samaniego F, Younes A, Romaguera J, Hagemeister F, Kwak L, Cabanillas F, Rodriguez M, Fayad L. The addition of rituximab to CHOP chemotherapy improves overall and failure-free survival for follicular grade 3 lymphoma. Ann Oncol 2008; 19:553-9. [DOI: 10.1093/annonc/mdm511] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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20
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Pham RN, Gooley TA, Keeney GE, Press OW, Pagel JM, Greisman HA, Bensinger WI, Holmberg LA, Petersdorf SH, Maloney DG, Gopal AK. The impact of histologic grade on the outcome of high-dose therapy and autologous stem cell transplantation for follicular lymphoma. Bone Marrow Transplant 2007; 40:1039-44. [DOI: 10.1038/sj.bmt.1705864] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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21
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Do recent reports of prolonged survival in patients with follicular lymphoma suggest that deferral of therapy is no longer justifiable? Curr Hematol Malig Rep 2007; 2:219-24. [PMID: 20425373 DOI: 10.1007/s11899-007-0030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
After an era in which it was unclear whether available systemic therapies for follicular lymphoma (FL) had influenced the survival of patients, several recent reports now suggest that survival of FL patients has improved over the past 25 years, presumably owing to expansion of therapeutic options. Has the pendulum swung so far that it is no longer justifiable to defer therapy in selected patients with FL? To date, the strongest evidence in support of treating all patients comes from randomized studies of different regimens suggesting that one offers a survival advantage over the other. The strongest evidence in support of deferring therapy for select patients comes from a few problematic randomized trials showing no difference between initial therapy and deferred therapy. The subset of patients with early-stage FL presents special but still inconclusive considerations. Accrual to prospective randomized trials is needed to answer the question.
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Abstract
PURPOSE OF REVIEW Follicular lymphoma grade 3 is recognized as a distinct entity in the World Health Organization classification of lymphomas. There is confusion regarding the natural history of these lymphomas, because some studies indicate an indolent behavior and others show more aggressive behavior. This review examines the biological and clinical characteristics of follicular lymphoma grade 3 and compares these characteristics with other lymphomas. RECENT FINDINGS Several reports suggest that follicular lymphoma grade 3 has molecular and genetic characteristics that distinguish these lymphomas from other grades of follicular lymphoma. These characteristics are often more common in patients with diffuse large B-cell lymphoma than follicular lymphoma. It is impossible to make firm recommendations on management because prospective trials are lacking. Nevertheless, recent studies have demonstrated that follicular lymphoma grade 3 patients treated with anthracycline-based therapy have similar outcomes to patients with diffuse large B-cell lymphoma. SUMMARY Patients with follicular lymphoma grade 3 should be treated with curative intent. They should receive aggressive anthracycline-based therapy combined with rituximab, which is identical to therapy used for patients with diffuse large B-cell lymphoma.
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MESH Headings
- Humans
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
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Affiliation(s)
- Philip J Bierman
- Department of Internal Medicine, Section of Oncology/Hematology, University of Nebraska Medical Center, Omaha, Nebraska 68198-7680, USA.
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23
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Lunning M, Armitage JO. The curability of follicular lymphoma. Transfus Apher Sci 2007; 37:31-5. [DOI: 10.1016/j.transci.2007.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 04/24/2007] [Indexed: 11/24/2022]
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24
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Abstract
The observed variability in the clinical course of follicular lymphoma (FL), along with the diverse range of therapeutic options available, necessitates accurate prognostic stratification of the individual patient. A number of clinical, laboratory, and pathologic parameters have been associated with both good and poor risk disease; in some instances these have been incorporated into readily calculable prognostic indices. With new insights into disease biology and the resulting identification of biomarkers that have arisen from the analysis of both the genome and the transcriptome, more accurate individualization of prognosis will be realized. At present the clinical application of such biomarkers, however, remains largely in its infancy. This review examines the clinical and molecular prognostic features that have been identified as of value in FL.
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Affiliation(s)
- Andrew J Davies
- Department of Medical Oncology, St Bartholomew's Hospital, West Smithfield, London, UK.
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25
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Krishnan A, Nademanee A, Fung H, Angelopoulou M, Molina A, Gaal K, Dagis A, Palmer J, Alvarnas J, Slovak M, Kogut N, Popplewell L, Rodriguez R, Schriber J, Wang S, Forman SJ. Does Follicularity in Large Cell Lymphoma Predict Outcome after Autologous Stem Cell Transplantation? Biol Blood Marrow Transplant 2006; 12:641-7. [PMID: 16737937 DOI: 10.1016/j.bbmt.2005.12.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Accepted: 12/28/2005] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to evaluate whether follicular histology in large cell lymphoma influences treatment outcomes after autologous stem cell transplantation (ASCT). It remains an area of controversy whether the natural history of follicular large cell lymphoma (FLCL) is akin to diffuse large cell lymphoma (DLCL) with curative potential or is more similar to indolent follicular lymphomas with a pattern of late relapses after intensive chemotherapy. Although ASCT is a potentially curative treatment for patients with recurrent DLCL, the effectiveness of this approach in patients with FLCL is unclear. We undertook a retrospective analysis of 332 patients with large cell lymphoma who underwent ASCT at the City of Hope Comprehensive Cancer Center. With a median follow-up of 31 months, the projected 10-year overall survival and disease-free survival were similar between patients with FLCL and DLCL. Analysis of prognostic factors demonstrated that although age, chemotherapy refractoriness, and disease status at the time of ASCT were predictive of overall survival/disease-free survival, follicularity did not influence the outcome. Furthermore, the similar plateau in the survival curve for the DLCL and FLCL patients suggests that the behavior of FLCL is similar to that of DLCL and that FLCL is potentially curable with ASCT.
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MESH Headings
- Adult
- Bone Marrow/pathology
- Disease-Free Survival
- Follow-Up Studies
- Humans
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Middle Aged
- Predictive Value of Tests
- Retrospective Studies
- Stem Cell Transplantation
- Survival Analysis
- Transplantation, Autologous
- Treatment Outcome
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Affiliation(s)
- Amrita Krishnan
- Division of Hematology/Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California 91010, USA.
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26
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Ganti AK, Weisenburger DD, Smith LM, Hans CP, Bociek RG, Bierman PJ, Vose JM, Armitage JO. Patients with grade 3 follicular lymphoma have prolonged relapse-free survival following anthracycline-based chemotherapy: the Nebraska Lymphoma Study Group Experience. Ann Oncol 2006; 17:920-7. [PMID: 16524969 DOI: 10.1093/annonc/mdl039] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The aim of the study was to determine the outcome and clinical features predictive of survival in patients with follicular lymphoma (FL) treated aggressively and to determine the rate of disease-specific mortality in patients with grade 3 FL (FL3). MATERIALS AND METHODS Four hundred and twenty-one patients with FL who were treated with various anthracycline-based chemotherapy regimens were included in this retrospective study. RESULTS Patients with FL3 and a diffuse component of >50% had the worst outcome, with a hazard ratio of dying of 2.2 (95% CI 1.4-3.4) compared with patients with FL1 or FL2, and a ratio of 1.6 (95% CI 1.02-2.5) compared with FL3 with a diffuse component of < or =50% by multivariate analysis (P = 0.0026). Patients with FL3a had an outcome similar to those with FL3b. In patients with FL3 and a diffuse component of < or =50%, the overall and event-free survival curves showed a plateau for patients younger than 60 years of age. However, there were no differences in the cumulative incidence of relapse/progression or lymphoma-specific/treatment-related mortality between the two age groups. CONCLUSIONS Less than half of the patients with FL3 and a diffuse component of < or =50% treated with anthracycline-based combination chemotherapy will relapse and relapses are uncommon after 6 years. Older patients should be offered the same aggressive chemotherapy as younger patients.
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Affiliation(s)
- A K Ganti
- Department of Internal Medicine, Division of Oncology/Hematology, University of Nebraska Medical Center, Omaha, USA
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27
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Katzenberger T, Ott G, Klein T, Kalla J, Müller-Hermelink HK, Ott MM. Cytogenetic alterations affecting BCL6 are predominantly found in follicular lymphomas grade 3B with a diffuse large B-cell component. THE AMERICAN JOURNAL OF PATHOLOGY 2004; 165:481-90. [PMID: 15277222 PMCID: PMC1618575 DOI: 10.1016/s0002-9440(10)63313-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recently, classical banding cytogenetic studies suggested that follicular lymphomas (FLs) grade 3 with preserved maturation to centrocytes (FL3A) are closely related to FL grades 1 and 2 and frequently harbor the t(14;18), whereas FL grade 3B, consisting of centroblasts exclusively, do frequently show 3q27 alterations. To clarify the prevalence of BCL6 and BCL2 rearrangements in FL and diffuse large B-cell lymphomas (DLBLs), we performed a large scale bicolor interphase cytogenetic (fluorescence in situ hybridization) study on 188 well-characterized B-NHLs classified according to the World Health Organization Classification of Tumors of the Lymphoid Tissues. BCL6 rearrangements were detected in a significantly higher number of FL3B with a DLBL component (12 of 22, 55%) compared with purely diffuse nodal DLBLs (19 of 77, 25%) and DLBLs with a well-documented primary extranodal origin (2 of 27, 7%) (P < 0.001). Five FL3B without a DLBL component were negative for both t(14;18) and 3q27 aberrations. FL grades 1/2 and FL3A were t(14;18)-positive in 88% and 64% of cases, respectively, but 3q27 alterations were identified in only four FL3A. These data exemplify different genetic pathways in the genesis of FLs with a high content of centroblasts and suggest that 3q27 rearrangements are predominantly associated with FL grade 3B harboring a DLBL component.
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MESH Headings
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 18/genetics
- Chromosomes, Human, Pair 3/genetics
- Cytogenetic Analysis
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Gene Rearrangement
- Humans
- Immunoenzyme Techniques
- In Situ Hybridization, Fluorescence
- Interphase
- Lymphoma, B-Cell/blood
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/blood
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/blood
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasm Staging
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/metabolism
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Proto-Oncogene Proteins c-bcl-6
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Translocation, Genetic/genetics
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Affiliation(s)
- Tiemo Katzenberger
- Institute of Pathology, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany.
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28
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Abstract
Apoptosis, the cell's intrinsic death program, is a key regulator of tissue homeostasis. An imbalance between cell death and proliferation may result in tumor formation. Also, killing of cancer cells by cytotoxic therapies such as chemotherapy, gamma-irradiation or ligation of death receptors is predominantly mediated by triggering apoptosis in target cells. In addition to the intrinsic mitochondrial pathway, elements of death receptor signaling pathways have been implied to contribute to the efficacy of cancer therapy. Failure to undergo apoptosis in response to anticancer therapy may lead to resistance. Also, deregulated expression of death receptor pathway molecules may contribute to tumorigenesis and tumor escape from endogenous growth control. Understanding the molecular events that regulate apoptosis induced by anticancer therapy and how cancer cells evade apoptosis may provide new opportunities for pathway-based rational therapy and for drug development.
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29
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Ewing JC, White JM, Rattray A, Lessells A, Mackie MJ. Total registration of non-Hodgkin's lymphoma and Hodgkin's disease in Scotland: effect of deprivation and caseload on outcome. Hematology 2003; 8:211-20. [PMID: 12911938 DOI: 10.1080/1024533031000135685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
All cases S16 years of age with a histological diagnosis of non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) presented in Scotland between 1 January 1994 and 31 December 1996 were registered prospectively in the Scotland and Newcastle Lymphoma Group database by a process of total registration. The census population of Scotland in 1996-1997 was 5.1 million. One thousand seven hundred and sixty three patients were registered with NHL and 350 patients with HD. These patients have been followed up for a median of 47 months in the case of NHL and 51 months for HD cases. Actuarial 5-year survival for adult NHL was 35% and for HD, 75%. Outcome for both NHL and HD was particularly poor in the population over 60 years with median survival of 18 months for NHL and 27 months for HD. When analysis of survival was related to degree of material deprivation using the Carstairs score a significantly poorer survival was seen for NHL with increasing deprivation that could not be explained by a different pattern of age or stage at presentation. Deprivation had no impact on incidence or survival in HD. Analysis of impact of caseload of the physician initiating therapy showed no significant difference in 5-year survival.
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Affiliation(s)
- J C Ewing
- Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road MBX 20 4, Manchester, UK
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30
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Chau I, Jones R, Cunningham D, Wotherspoon A, Maisey N, Norman AR, Jain P, Bishop L, Horwich A, Catovsky D. Outcome of follicular lymphoma grade 3: is anthracycline necessary as front-line therapy? Br J Cancer 2003; 89:36-42. [PMID: 12838297 PMCID: PMC2394229 DOI: 10.1038/sj.bjc.6601006] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A grading system (grades 1-3) for follicular lymphoma (FL) is used in the WHO classification for lymphoid malignancies based on the absolute number of centroblasts in the neoplastic follicles. Grade 3 FL is further subdivided into 3a and 3b depending on the presence or absence of centrocytes. A total of 231 patients with FL, referred from 1970 to 2001, were identified from our prospectively maintained database. Original diagnostic materials were available for review on 215 patients and these were reclassified according to the WHO grading system. Follicular lymphoma grades 1, 2 and 3 accounted for 92, 68 and 55 patients, respectively. No significant overall survival (OS) differences were observed among FL grades 1-3 (log rank P=0.25) or between grades 3a and 3b (log rank P=0.20). No significant failure-free survival (FFS) differences were observed among FL grades 1-3 (log rank P=0.72) or between grades 3a and 3b (log rank P=0.11). First-line anthracyclines did not influence OS or FFS (log rank P=0.86, P=0.58, respectively) in patients with FL grade 3. There are long-term survivors among patients with FL grade 3 with a continuing risk of relapse. Anthracyclines did not appear to influence survival or disease relapses when given as front-line therapy in our series. The role of anthracyclines should be further evaluated in large randomised studies.
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Affiliation(s)
- I Chau
- Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - R Jones
- Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - D Cunningham
- Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK
- Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK. E-mail:
| | - A Wotherspoon
- Department of Histopathology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - N Maisey
- Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - A R Norman
- Department of Computing, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - P Jain
- Academic Department of Haematology, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - L Bishop
- Department of Medicine, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - A Horwich
- Department of Academic Radiotherapy, Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - D Catovsky
- Academic Department of Haematology, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
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31
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Hans CP, Weisenburger DD, Vose JM, Hock LM, Lynch JC, Aoun P, Greiner TC, Chan WC, Bociek RG, Bierman PJ, Armitage JO. A significant diffuse component predicts for inferior survival in grade 3 follicular lymphoma, but cytologic subtypes do not predict survival. Blood 2003; 101:2363-7. [PMID: 12424193 DOI: 10.1182/blood-2002-07-2298] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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Affiliation(s)
- Christine P Hans
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198-3135, USA
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32
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Horsman DE, Okamoto I, Ludkovski O, Le N, Harder L, Gesk S, Siebert R, Chhanabhai M, Sehn L, Connors JM, Gascoyne RD. Follicular lymphoma lacking the t(14;18)(q32;q21): identification of two disease subtypes. Br J Haematol 2003; 120:424-33. [PMID: 12580956 DOI: 10.1046/j.1365-2141.2003.04086.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The clinical and pathological features, including karyotype data and BCL2 protein expression pattern, of follicular lymphoma without a t(14;18)(q32;q21) have not been well defined. We have identified and conducted a detailed analysis of 50 cases with follicular lymphoma who lack the t(14;18). Fluorescent in situ hybridization (FISH) analysis was used to exclude cases with a cryptic IGH/BCL2 rearrangement. BCL2 protein expression level was assessed by immunohistochemistry. The karyotypes were assessed for recurrent sites of structural rearrangement, duplications and deletions on a band-by-band basis, and compared with a large cohort of cases with t(14;18). A distinct pattern of chromosomal alterations was identified in the cases without t(14;18). BCL2 protein overexpression was detected in 33% of 49 tested cases. In this minority, the karyotypes frequently showed increased copies of chromosome 18. The majority of cases (67%) did not show BCL2 overexpression and were characterized prominently by the presence of t(3;14)(q27;q32), implying a role for BCL6. Follicular lymphomas that lack a t(14;18) were segregated into two subgroups with distinct cytogenetic, phenotypic and possibly clinical features: one with BCL2 protein overexpression not related to an IGH/BCL2 rearrangement and a second without BCL2 overexpression. Objective identification of BCL2 expression level as well as BCL2 and BCL6 status by cytogenetic or FISH analysis has potential clinical utility and may yield insights into alternative genetic mechanisms associated with B-cell lymphomas with a follicular growth pattern.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 18/genetics
- Chromosomes, Human, Pair 3/genetics
- Female
- Humans
- Immunophenotyping
- In Situ Hybridization, Fluorescence
- Karyotyping
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/metabolism
- Male
- Middle Aged
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Translocation, Genetic
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Affiliation(s)
- Douglas E Horsman
- Pathology and Laboratory Medicine Division, British Columbia Cancer Agency, Canada.
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33
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Bosga-Bouwer AG, van Imhoff GW, Boonstra R, van der Veen A, Haralambieva E, van den Berg A, de Jong B, Krause V, Palmer MC, Coupland R, Kluin PM, van den Berg E, Poppema S. Follicular lymphoma grade 3B includes 3 cytogenetically defined subgroups with primary t(14;18), 3q27, or other translocations: t(14;18) and 3q27 are mutually exclusive. Blood 2003; 101:1149-54. [PMID: 12529293 DOI: 10.1182/blood.v101.3.1149] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chromosomal translocations involving t(14;18)(q32;q21) and the chromosome 3q27 region are common in B-cell non-Hodgkin lymphoma of germinal center cell origin. Grade 3B follicular lymphoma (FL), consisting almost exclusively of centroblasts, is a distinct subgroup of follicular lymphomas that has more in common clinically with the aggressive diffuse large B-cell lymphomas than with their indolent FL grade 1 and 2 counterparts. We studied the cytogenetic and molecular genetic aberrations by classic cytogenetics, polymerase chain reaction, Southern blot hybridization, and fluorescence in situ hybridization, with special emphasis on t(14;18), affecting bcl-2, and 3q27 rearrangement, affecting bcl-6, in 32 cases of FL grade 3B. Three distinctive subgroups were identified based upon the existence of breakpoint 3q27, a translocation t(14;18), or the absence of both. Group I involved a t(14;18) and no 3q27 aberrations (n = 13); group II was without a t(14;18) and without 3q27 aberrations (n = 9), but had other cytogenetic aberrations; and group III was without a t(14;18) but with aberrations involving 3q27 (n = 10). None of the FL grade 3B cases harbored both a t(14;18) and 3q27 aberration. These results, in particular the finding of a mutual exclusiveness of bcl-2 and bcl-6 rearrangement, indicate at least 3 different pathways of oncogenesis in FL grade 3B. FL grade 3B with bcl-2 rearrangement probably is part of the same entity as the other follicular lymphomas (1, 2, 3A), whereas the cases with 3q27 abnormalities or other unrelated translocations are more closely related to the majority of diffuse large-cell lymphomas of germinal center cell origin.
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MESH Headings
- Cell Transformation, Neoplastic/genetics
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Chromosomes, Human, Pair 3
- Cytogenetic Analysis
- DNA-Binding Proteins/genetics
- Gene Rearrangement
- Genes, bcl-2
- Humans
- Lymphoma, Follicular/classification
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins c-bcl-6
- Transcription Factors/genetics
- Translocation, Genetic
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34
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Peterson BA, Petroni GR, Frizzera G, Barcos M, Bloomfield CD, Nissen NI, Hurd DD, Henderson ES, Sartiano GP, Johnson JL, Holland JF, Gottlieb AJ. Prolonged single-agent versus combination chemotherapy in indolent follicular lymphomas: a study of the cancer and leukemia group B. J Clin Oncol 2003; 21:5-15. [PMID: 12506163 DOI: 10.1200/jco.2003.05.128] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The array of options for the initial management of follicular small cleaved lymphoma (FSCL) and follicular mixed lymphoma (FML) ranges from little or no therapy to the use of intensive combinations of drugs. The Cancer and Leukemia Group B (CALGB) compared two contrasting approaches: a single agent, and combination chemotherapy capable of curing diffuse aggressive lymphomas. PATIENTS AND METHODS A total of 228 patients with stage III or IV FSCL or FML were randomized to cyclophosphamide or the combination of cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-B). Treatment was continued in responders for 2 years beyond maximal response. The primary end point was survival in the most common subtype, FSCL. RESULTS Ninety-one percent of all patients responded; complete responses were seen in 66% of those treated with cyclophosphamide and in 60% treated with CHOP-B (P =.36). At 10 years with either cyclophosphamide or CHOP-B, respectively, overall time to failure (25% failure free v 33%; P =.107) and survival (44% alive v 46%; P =.79) were similar by treatment. Outcomes in FSCL also were similar. In 46 patients with FML, at 10 years the combination was associated with better failure-free (9% v 48%; P =.005) and overall (25% v 61%; P =.024) survival. Acute toxic effects were more common with combination chemotherapy. Second malignancies, which might be attributed to treatment, were seen with both approaches. CONCLUSION There is no advantage to the initial use of the relatively intensive combination, CHOP-B, for patients with FSCL compared with the less toxic single agent, cyclophosphamide. However, in an unplanned subgroup analysis, patients with FML who received the combination experienced improved disease control and survival.
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Affiliation(s)
- Bruce A Peterson
- University of Minnesota Medical School, Division of Hematology, Oncology and Transplantation, Minneapolis, MN 55455, USA.
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35
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Jäeger G, Neumeister P, Brezinschek R, Höfler G, Quehenberger F, Linkesch W, Sill H. Rituximab (anti-CD20 monoclonal antibody) as consolidation of first-line CHOP chemotherapy in patients with follicular lymphoma: a phase II study. Eur J Haematol 2002; 69:21-6. [PMID: 12270058 DOI: 10.1034/j.1600-0609.2002.01692.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Advanced stages of follicular lymphoma are deemed incurable by conventional approaches. Immunotherapy with the humanised monoclonal anti-CD20 antibody rituximab represents a new therapeutic option. The aim of our study was to determine the effectiveness and safety of rituximab in the consolidation setting of first-line treated patients with follicular lymphomas. Thus the goal was first to reduce tumour burden using the CHOP regimen as induction treatment followed by consolidation with rituximab administered on a standard 4 wk schedule at a dosage of 375 mg m-2 body surface area. Between August 1998 and April 2001, 41 patients were enrolled in the study. All patients were evaluable with regard to tumour response and toxicity. The overall remission rate in the intent-to-treat analysis was 100%. On subgroup analysis, 20 [83% (95% CI: 63-95%)] of the 24 patients with grade 1 or 2 histology entered complete remission (CR), in 10 cases (42%) after additional rituximab therapy. Rituximab thus led to CR in 10/14 patients [71% (95% CI: 42-92%)] who had merely achieved partial remission (PR) with CHOP. Of 16 evaluable patients with grade 3 histology (excluding one patient achieving CR on CHOP who refused further treatment with rituximab), 15 [94% (95% CI: 63-97%)] achieved CR, 13 (81%) of these while still receiving CHOP. Two of the three patients achieving only PR on CHOP entered CR following rituximab. Thirty-four patients (83%) continued to be in remission during a median follow-up period of 24.3 (9-40) months. Our data suggest that the use of rituximab for consolidation after CHOP may improve CHOP-induced remission and thus increase the CR rate. Furthermore, it was accompanied by a reduced rate of infusion-related side-effects.
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Affiliation(s)
- Gerald Jäeger
- Department of Hematology, Karl-Franzens University, Graz, Austria.
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36
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Maartense E, Le Cessie S, Kluin-Nelemans HC, Kluin PM, Snijder S, Wijermans PW, Noordijk EM. Age-related differences among patients with follicular lymphoma and the importance of prognostic scoring systems: analysis from a population-based non-Hodgkin's lymphoma registry. Ann Oncol 2002; 13:1275-84. [PMID: 12181252 DOI: 10.1093/annonc/mdf198] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The influence of age on the outcome of follicular non-Hodgkin's lymphoma (FL) was studied in a population-based non-Hodgkin's lymphoma registry. PATIENTS AND METHODS This study comprised 214 follicular lymphoma patients. Grade I/II was considered separately from grade III FL. The data were analyzed with respect to three age groups: <60, 60-69 and >or=70 years. RESULTS The overall survival rate decreased in the older age groups. Grade III patients showed a statistically significant decrease in overall survival in comparison with grade I/II patients (P = 0.03). Cause-specific survival analysis showed that in the older age groups, there was an increasing influence of concomitant disease on the death rate, especially among grade III FL patients >70 years of age. The survival curve in grade III FL patients was shown to reach a plateau. The prognostic scoring system, according to the Italian Lymphoma Intergroup, fitted better to grade I/II patients, while the International Prognostic Index showed better discrimination amongst grade III patients. CONCLUSIONS Separate grading for follicular lymphoma is useful. An age >70 years has a negative impact on outcome, but the contribution of concomitant disease herein is important. Different prognostic scoring systems should be applied to the different grades of FL.
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Affiliation(s)
- E Maartense
- Department of Internal Medicine, Reinier de Graaf Gasthuis, Reinier de Graafweg, The Netherlands.
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37
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Igarashi T, Kobayashi Y, Ogura M, Kinoshita T, Ohtsu T, Sasaki Y, Morishima Y, Murate T, Kasai M, Uike N, Taniwaki M, Kano Y, Ohnishi K, Matsuno Y, Nakamura S, Mori S, Ohashi Y, Tobinai K. Factors affecting toxicity, response and progression-free survival in relapsed patients with indolent B-cell lymphoma and mantle cell lymphoma treated with rituximab: a Japanese phase II study. Ann Oncol 2002; 13:928-43. [PMID: 12123339 DOI: 10.1093/annonc/mdf155] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of the study was to determine factors affecting the toxicity and efficacy of rituximab monotherapy in relapsed patients with indolent B-cell lymphoma and mantle cell lymphoma (MCL). PATIENTS AND METHODS A total of 90 patients were enrolled and treated with rituximab infusions at 375 mg/m2 once weekly for 4 weeks. Central pathology review revealed that histologically, 81 patients had indolent B-cell lymphoma or MCL: 59 with follicular lymphoma, 17 with MCL, four with marginal zone lymphoma and one with lymphoplasmacytoid lymphoma. Of these, four were ineligible due to violation of other eligibility criteria. Pre-treatment variables affecting toxicities were analyzed for all 90 patients, and those affecting response and progression-free survival (PFS) were analyzed for 77 eligible patients with confirmed indolent B-cell lymphoma or MCL. The relationship between serum rituximab levels and efficacy was also analyzed for 66 eligible patients. RESULTS Hematological toxicities (grade > or =3) occurred more frequently in females (P <0.05), and thrombocytopenia and leukopenia were more frequent in patients with high lactate dehydrogenase (LDH) levels (P <0.05). Non-hematological toxicities (grade > or =2) were more frequent in patients with extranodal disease or bone marrow involvement. The overall response rate (ORR) in patients receiving one prior chemotherapy regimen was higher than those receiving two or more regimens (P <0.05). The median PFS was shorter in MCL patients, in those with extranodal disease, or in those receiving two or more prior chemotherapy regimens (P <0.01). The PFS intervals of patients with higher serum rituximab levels (> or =70 microg/ml) immediately before the third infusion were longer than in other patients (P <0.01). CONCLUSIONS Several prognostic factors and serum rituximab levels are useful for predicting the toxicity and efficacy of rituximab monotherapy.
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MESH Headings
- Adult
- Aged
- Analysis of Variance
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Murine-Derived
- Biopsy, Needle
- Confidence Intervals
- Disease-Free Survival
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Drug-Related Side Effects and Adverse Reactions
- Female
- Humans
- Japan
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/mortality
- Lymphoma, B-Cell/pathology
- Lymphoma, Mantle-Cell/drug therapy
- Lymphoma, Mantle-Cell/mortality
- Lymphoma, Mantle-Cell/pathology
- Male
- Maximum Tolerated Dose
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Probability
- Risk Factors
- Rituximab
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- T Igarashi
- Hematology and Oncology Division, National Cancer Center Hospital East, Kashiwa, Tokyo, Japan
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38
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Ott G, Katzenberger T, Lohr A, Kindelberger S, Rüdiger T, Wilhelm M, Kalla J, Rosenwald A, Müller JG, Ott MM, Müller-Hermelink HK. Cytomorphologic, immunohistochemical, and cytogenetic profiles of follicular lymphoma: 2 types of follicular lymphoma grade 3. Blood 2002; 99:3806-12. [PMID: 11986240 DOI: 10.1182/blood.v99.10.3806] [Citation(s) in RCA: 219] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Follicular lymphoma (FL) grades 1 and 2 are regarded as a distinct disease entity, whereas data suggest that FL grade 3 might be an inhomogeneous tumor category. To define the biologic spectrum of FL, 89 follicular lymphomas were studied for their cytologic composition, antigen expression, mitotic and proliferation indices, cytogenetics, and clinical data. In contrast to the homogeneous appearance of FL grades 1 and 2 (29 and 33 cases, respectively), 2 types of FL grade 3 were recognized. Eleven cases of FL 3a displayed structural features similar to those of FL 1 and 2 and were composed of centroblasts and centrocytes, whereas 16 cases of FL 3b, with (n = 4) or without (n = 12) a diffuse large B-cell lymphoma component (DLBL) (FL 3b +/- DLBL), consisted exclusively of blasts. In contrast to FL 3a, FL 3b +/- DLBL were CD10(+) in only 50% of cases and displayed plasmacytoid differentiation in 44% of cases. Although FL3a was t(14;18)+ in 8 of 11 (73%) cases, only 2 of 16 (13%) FL3b +/- DLBLs harbored this translocation. In contrast, chromosomal breaks at 3q27 were encountered in 7 of 16 (44%) FL 3b +/- DLBL in contrast to only 2 of 11 (18%) FL 3a, and the spectrum of secondary aberrations in FL 3b +/- DLBL was similar to that of diffuse large B-cell lymphoma. We conclude, therefore, that FL grade 3 is a heterogeneous disease group and that the distinction proposed in the new World Health Organization classification between FL 3a (with centrocytes) and FL3b (without centrocytes) is of biologic, and possibly clinical, importance.
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Affiliation(s)
- German Ott
- Pathologisches Institut and Poliklinik für Innere Medizin, University of Würzburg, Germany.
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39
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Falini B, Mason DY. Proteins encoded by genes involved in chromosomal alterations in lymphoma and leukemia: clinical value of their detection by immunocytochemistry. Blood 2002; 99:409-26. [PMID: 11781220 DOI: 10.1182/blood.v99.2.409] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acquired chromosomal anomalies (most commonly translocations) in lymphoma and leukemia usually result in either activation of a quiescent gene (by means of immunoglobulin or T-cell-receptor promotors) and expression of an intact protein product, or creation of a fusion gene encoding a chimeric protein. This review summarizes current immunocytochemical studies of these 2 categories of oncogenic protein, with emphasis on the clinical relevance of their detection in diagnostic samples. Among the quiescent genes activated by rearrangement, expression of cyclin D1 (due to rearrangement of the CCND1 [BCL-1] gene) is a near-specific marker of t(11;14) in mantle cell lymphoma; BCL-2 expression distinguishes follicular lymphoma cells from their nonneoplastic counterparts in reactive germinal centers and appears to be an independent prognostic marker in diffuse large cell lymphoma; and TAL-1 (SCL) expression identifies T-cell acute lymphoblastic neoplasms in which this gene is activated. The protein products of other genes activated by chromosomal rearrangement have a role as markers of either lineage (eg, PAX-5 [B-cell-specific activator protein] for B cells, including B-lymphoblastic neoplasms), or maturation stage (eg, BCL-6 for germinal-center and activated B cells and MUM-1/IRF4 for plasma cells). Currently, no hybrid protein encoded by fusion genes is reliably detectable by antibodies recognizing unique junctional epitopes (ie, epitopes absent from the wild-type constituent proteins). Nevertheless, staining for promyelocytic leukemia (PML) protein will detect acute PML with t(15;17) because the microspeckled nuclear labeling pattern for PML-RARalpha is highly distinctive. Similarly, antibodies to the anaplastic lymphoma kinase (ALK) tyrosine kinase are valuable (because wild-type ALK is not found in normal lymphoid tissue) in detecting neoplasms (CD30-positive large T-cell lymphomas) with t(2;5) or its variants. Thus, immunocytochemical detection of the products of many rearranged genes in lymphoma and leukemia can be clinically informative and provide information on cellular and subcellular protein expression that cannot be inferred from studies based on messenger RNA.
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MESH Headings
- Animals
- Antibodies, Monoclonal/immunology
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/immunology
- Cell Lineage
- Chromosome Aberrations
- Chromosomes, Human/genetics
- Chromosomes, Human/ultrastructure
- Embryonal Carcinoma Stem Cells
- Gene Expression Profiling
- Humans
- Immunohistochemistry
- Leukemia/classification
- Leukemia/diagnosis
- Leukemia/genetics
- Leukemia/metabolism
- Lymphoma/classification
- Lymphoma/diagnosis
- Lymphoma/genetics
- Lymphoma/metabolism
- Mice
- Neoplasm Proteins/analysis
- Neoplasm Proteins/genetics
- Neoplasm Proteins/immunology
- Neoplastic Stem Cells/metabolism
- Oligonucleotide Array Sequence Analysis
- Oncogene Proteins, Fusion/analysis
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/immunology
- Oncogenes
- Organ Specificity
- Prognosis
- RNA, Messenger/genetics
- RNA, Neoplasm/genetics
- Translocation, Genetic/genetics
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40
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Kondo E, Ogura M, Kagami Y, Taji H, Miura K, Takeuchi T, Maeda S, Asakura S, Suzuki R, Nakamura S, Morishima Y. Assessment of prognostic factors in follicular lymphoma patients. Int J Hematol 2001; 73:363-8. [PMID: 11345204 DOI: 10.1007/bf02981963] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Prognostic factors, including clinical, biological, and histological parameters, were assessed for 94 patients with follicular lymphomas at our institute. Follicular lymphomas constituted 7.7% (94/1208) of malignant lymphomas in this study. Eighteen patients were diagnosed with stage I follicular lymphoma, 20 with stage II, 23 with stage III, and 33 with stage IV. The cases of follicular lymphoma were subclassified as: follicular small cleaved cell lymphoma (FSC) in 20 cases, follicular mixed cell lymphoma (FMX) in 59 cases, and follicular large cell lymphoma (FLC) in 15 cases. The patients comprised 49 men and 45 women with a median age of 54 years (range, 25-84 years). The complete response rate was 76.5%, and the median survival time was 13 years. The expected 10-year overall survival and event-free survival rates were 61.9% and 38.2%, respectively. Univariate analysis identified the factors associated with poor survival as elevated serum lactate dehydrogenase (LDH) level (P < .0001), age of >60 (P < .0001), Ann Arbor stage III/IV (P < .01), and Eastern Cooperative Oncology Group performance status (PS) of 2 to 4 (P = .048). Multivariate analysis showed that LDH, age, and PS were independent predictors. After application of the International Prognostic Index (IPI), the 10-year survival rates for the low-risk, low-intermediate risk, high-intermediate risk and high-risk groups were 80.4%, 48.7%, 21.9%, and 0.0%, respectively. The differences among these groups were significant at P < .01. The IPI for aggressive non-Hodgkin's lymphoma was found to be applicable to survival prediction for Japanese follicular lymphoma patients.
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Affiliation(s)
- E Kondo
- Department of Hematology and Chemotherapy, Aichi Cancer Center Hospital, Nagoya, Japan
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41
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Takeshita M, Iwashita A, Kurihara K, Ikejiri K, Higashi H, Udoh T, Kikuchi M. Histologic and immunohistologic findings and prognosis of 40 cases of gastric large B-cell lymphoma. Am J Surg Pathol 2000; 24:1641-9. [PMID: 11117785 DOI: 10.1097/00000478-200012000-00008] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It has been considered that gastric large B cell lymphoma mainly consists of mucosa-associated lymphoid tissue lymphoma (MALToma) with large cell transformation. However, debate continues about the cell lineage. We analyzed 61 operated cases of gastric B cell lymphoma, mainly focusing on 40 cases of diffuse large cell lymphoma (DLCL). Immunohistologically, two cases were classified as CD10-positive follicular lymphoma, 19 cases were low-grade MALToma, 11 CD10-negative DLCL with a component of low-grade MALToma (high-grade MALToma), 12 CD10-positive DLCL, and 17 CD10-negative DLCL without MALToma (pure DLCL). Lymphoepithelial lesion (LEL) was found in all -cases of high-grade MALToma, and in eight of these its invasion was confined to the mucosa and submucosa. Expression of Bcl-6 was detected in two cases of high-grade MALToma. Only two cases of CD10-positive DLCL had large cell LEL, and seven cases showed tumor invasion beyond the submucosa. All 12 cases were positive for Bcl-6, and a delicate meshwork of CD35 (Ber-MAC-DRC)-positive follicular dendritic cells was detected in eight cases. Pure DLCL of all 17 cases reached the proper muscle layer or more, and expression of Bcl-6 was detected in 10 cases. For patients with pure DLCL, overall survival was significantly (p <0.05) worse than those of high-grade MALToma and CD10-positive DLCL by Kaplan-Meier and log-rank methods. Clinical staging and Bcl-6 expression were also good prognostic factors in patients with DLCL. Three groups of gastric DLCL each had unique histologic findings, immunohistologic characteristics, and prognosis.
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MESH Headings
- Aged
- Female
- Humans
- Immunohistochemistry
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/surgery
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/surgery
- Lymphoma, Non-Hodgkin/metabolism
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/surgery
- Male
- Middle Aged
- Neprilysin/analysis
- Prognosis
- Stomach Neoplasms/metabolism
- Stomach Neoplasms/pathology
- Stomach Neoplasms/surgery
- Survival Analysis
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Affiliation(s)
- M Takeshita
- Department of Pathology, Clinical Laboratory, National Kyushu Medical Center Hospital, Fukuoka, Japan.
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42
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Rodriguez J, McLaughlin P, Fayad L, Santiago M, Hess M, Rodriguez MA, Romaguera J, Hagemeister F, Kantarjian H, Cabanillas F. Follicular large cell lymphoma: long-term follow-up of 62 patients treated between 1973-1981. Ann Oncol 2000; 11:1551-6. [PMID: 11205462 DOI: 10.1023/a:1008330311886] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Investigators disagree on whether follicular large cell lymphoma (FLCL) behaves like other follicular lymphomas, with no plateau in the survival curve, or as a more aggressive but potentially curable lymphoma. We reported in 1984 results for 62 FLCL patients treated at our institution; the current report updates those results. PATIENTS AND METHODS Sixty-two patients referred from 1973-1981, including fifteen (24%) patients with Ann Arbor stage I-II and forty-seven (76%) with stage III-IV FLCL. Seven patients received radiation (XRT) alone, forty patients XRT and chemotherapy, and fifteen patients received chemotherapy alone. RESULTS The median follow-up was 14.7 years. The median survival was 5.1 years, with 21% alive at 15 years. The failure-free survival (FFS) at 10 years was 31%. Univariate analysis revealed that age, Ann Arbor stage, and the International Index correlated with survival. Performance status, number of platelets, and LDH correlated with failure-free survival. CONCLUSIONS FLCL responds to doxorubicin-based regimens similarly to diffuse large cell lymphoma. Patients with FLCL have the potential for prolonged failure-free survival. Variables that predict the survival in aggressive lymphomas apply as well in this type of lymphoma.
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Affiliation(s)
- J Rodriguez
- University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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43
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Cornfield DB, Mitchell DM, Almasri NM, Anderson JB, Ahrens KP, Dooley EO, Braylan RC. Follicular lymphoma can be distinguished from benign follicular hyperplasia by flow cytometry using simultaneous staining of cytoplasmic bcl-2 and cell surface CD20. Am J Clin Pathol 2000; 114:258-63. [PMID: 10941341 DOI: 10.1309/vjtk-djwa-x297-xf8q] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The distinction between benign follicular hyperplasia (FH) and follicular lymphoma (FL) is sometimes problematic. We wanted to determine whether the expression of bcl-2 of FH was quantitatively different from that of FL, using surface CD20 expression as a discriminator of the various lymphoid compartments. Lymph node cell suspensions from 12 cases of FH and 17 cases of FL were analyzed by flow cytometry using a combined surface CD20 and intracellular bcl-2 staining. CD20- T cells in FH demonstrated the same bcl-2 expression as the CD20+ mantle cells, but the bright CD20+ germinal center cells showed near absence of bcl-2 expression. In contrast, the neoplastic cells of FL showed greater bcl-2 expression than the T cells of the same tumors and all cell populations of FH. This difference was particularly significant between the neoplastic B cells of FL and the germinal center cells of FH. The combined analysis of CD20 and bcl-2 should be useful for the differential diagnosis between FH and FL and particularly applicable to limited samples or when B-cell clonality is in question. Whether the quantitation of bcl-2 expression can be of further discriminatory value in malignant lymphomas remains to be determined.
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Affiliation(s)
- D B Cornfield
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Gainesville 32610, USA
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44
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Weisenburger DD, Gascoyne RD, Bierman PJ, Shenkier T, Horsman DE, Lynch JC, Chan WC, Greiner TC, Connors JM, Vose JM, Armitage JO, Sanger WG. Clinical significance of the t(14;18) and BCL2 overexpression in follicular large cell lymphoma. Leuk Lymphoma 2000; 36:513-23. [PMID: 10784396 DOI: 10.3109/10428190009148399] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Follicular large cell lymphoma (FLCL) is an aggressive disease that responds to anthracycline-containing chemotherapy much like diffuse large B-cell lymphoma (DLBCL). Since the t(14;18) and/or bcl2 protein expression are less common in FLCL than in its low-grade counterparts, we sought to determine whether these features were predictive of survival as in DLBCL. We studied 50 patients with FLCL who were treated with curative intent. The t(14;18) was found by cytogenetic analysis in 56% of the patients and bcl2 protein was expressed by the tumor cells in 73%, but neither was predictive of survival. However, abnormalities of chromosome 17p and the presence of trisomy 21 were adverse predictors of survival, as were a number of clinical features. We conclude that neither the absence of the t(14;18) nor the lack of bcl2 expression explain the good response of a subset of patients with FLCL to curative therapy.
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MESH Headings
- Aged
- Biomarkers, Tumor
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Female
- Genes, bcl-2
- Genetic Markers
- Humans
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/physiopathology
- Male
- Middle Aged
- Prognosis
- Survival Analysis
- Translocation, Genetic
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Affiliation(s)
- D D Weisenburger
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha 68198-3135, USA
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45
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Follicular Large Cell Lymphoma: An Aggressive Lymphoma That Often Presents With Favorable Prognostic Features. Blood 1999. [DOI: 10.1182/blood.v93.7.2202.407a07_2202_2207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
It is debated whether follicular large cell lymphoma (FLCL) has a clinical behavior that is distinct from indolent follicular lymphomas, and whether there is a subset of patients who can be potentially cured. We report here our experience with 100 FLCL patients treated at our institution since 1984 with three successive programs. We evaluated the predictive value of pretreatment clinical features, including two risk models, the Tumor Score System and the International Prognostic Index (IPI). With a median follow-up of 67 months, the 5-year survival is 72% and the failure-free survival (FFS) is 67%, with a possible plateau in the FFS curve, particularly for patients with stage I-III disease. Features associated with shorter survival included age ≥60, elevated lactic dehydrogenase (LDH) or beta-2-microglobulin (β2M), advanced stage, and bone marrow involvement. Stage III patients had significantly better survival than stage IV patients (P < .05). By the IPI and Tumor Score System, 80% of the patients were in the lower risk groups; both systems stratified patients into prognostic groups. Patients with FLCL have clinical features and response to treatment similar to that reported for diffuse large cell lymphoma. Prognostic risk systems for aggressive lymphomas are useful for FLCL. A meaningful fraction of patients may possibly be cured when treated as aggressive lymphomas.
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46
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Follicular Large Cell Lymphoma: An Aggressive Lymphoma That Often Presents With Favorable Prognostic Features. Blood 1999. [DOI: 10.1182/blood.v93.7.2202] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
It is debated whether follicular large cell lymphoma (FLCL) has a clinical behavior that is distinct from indolent follicular lymphomas, and whether there is a subset of patients who can be potentially cured. We report here our experience with 100 FLCL patients treated at our institution since 1984 with three successive programs. We evaluated the predictive value of pretreatment clinical features, including two risk models, the Tumor Score System and the International Prognostic Index (IPI). With a median follow-up of 67 months, the 5-year survival is 72% and the failure-free survival (FFS) is 67%, with a possible plateau in the FFS curve, particularly for patients with stage I-III disease. Features associated with shorter survival included age ≥60, elevated lactic dehydrogenase (LDH) or beta-2-microglobulin (β2M), advanced stage, and bone marrow involvement. Stage III patients had significantly better survival than stage IV patients (P < .05). By the IPI and Tumor Score System, 80% of the patients were in the lower risk groups; both systems stratified patients into prognostic groups. Patients with FLCL have clinical features and response to treatment similar to that reported for diffuse large cell lymphoma. Prognostic risk systems for aggressive lymphomas are useful for FLCL. A meaningful fraction of patients may possibly be cured when treated as aggressive lymphomas.
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Knowlton K, Mancini M, Creason S, Morales C, Hockenbery D, Anderson BO. Bcl-2 slows in vitro breast cancer growth despite its antiapoptotic effect. J Surg Res 1998; 76:22-6. [PMID: 9695733 DOI: 10.1006/jsre.1998.5277] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although the Bcl-2 protein promotes tumor cell survival by blocking programmed cell death (apoptosis), Bcl-2 expression has been associated with favorable prognostic indicators in breast cancer. We hypothesize that despite its antiapoptotic effects, Bcl-2 slows tumor cell proliferation. MATERIALS AND METHODS Bcl-2-negative breast cancer cells (SKBr3) were transfected with the bcl-2 gene (Bcl2-1 clone, low expression; Bcl2-2 clone, high expression) or plasmid control (Neo). Cell cycle distribution and kinetics were analyzed using bivariate flow cytometry (PI staining and pulse BrdU uptake). Cells were treated for 72 h with doxorubicin (100 ng/ml) or vehicle (0.01% DMSO) and assayed for cytosolic DNA with diphenylamine to measure apoptosis. RESULTS Cell counting showed increased doubling time in the Bcl-2-expressing clones Bcl2-1 and Bcl2-2 (Bcl-2(+)) relative to the Bcl-2-nonexpressing lines SKBr3 and Neo (Bcl-2(-)). Cell cycle analysis showed a decreased S phase fraction in Bcl-2(+) cells. Pulse BrdU uptake showed an increased G1/G0 fraction in Bcl-2(+) cells. Doxorubicin-induced apoptosis occurred in Bcl-2(-) but not in Bcl-2(+) cell lines. CONCLUSIONS Despite antiapoptotic effects favoring tumor survival, Bcl-2 prolongs cell cycle. Decreased tumor proliferation may account for the association of Bcl-2 expression with a favorable outcome in breast cancer, even though Bcl-2 may mediate chemoresistance in some patients.
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Affiliation(s)
- K Knowlton
- Department of Surgery, University of Washington, Seattle 98195, USA
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