Risk Factors of Follicular Lymphoma

INTRODUCTION: Non-Hodgkin Lymphoma (NHL) is a heterogeneous group of malignancies with over thirty different subtypes. Follicular lymphoma (FL) is the most common form of indolent NHL and the second most common form of NHL overall. It has morphologic, immunophenotypic and clinical features significantly different from other subtypes. Considerable effort has been devoted to the identification of risk factors for etiology and prognosis of FL. These risk factors may advance our understanding of the biology of FL and have an impact on clinical practice. AREAS COVERED: The epidemiology of NHL and FL is briefly reviewed. For FL etiology and prognosis separately, we review clinical, environmental and molecular (including genetic, genomic, epigenetic and others) risk factors suggested in the literature. EXPERT OPINION: A large number of potential risk factors have been suggested in recent studies. However, there is a lack of consensus, and many of the suggested risk factors have not been rigorously validated in independent studies. There is a need for large-scale, prospective studies to consolidate existing findings and discover new risk factors. Some of the identified risk factors are successful at the population level. More effective individual-level risk factors and models remain to be identified.

Prognostic biomarkers in malignant lymphomas

There has recently been a rapid expansion in research aimed at identifying biomarkers that could improve the prognosis for patients with various subtypes of malignant lymphoma. Genomic and genetic studies have led to the identification of biological and clinical subgroups of diffuse large B-cell lymphomas with distinct underlying molecular features, divergent activation of oncogenetic pathways, and clinical course. Molecular studies of follicular lymphoma have suggested complex interactions between malignant cells and the surrounding immunological network that could affect disease progression. Moreover, the inflammatory cells of Hodgkin lymphoma have been shown to produce a complex network of cytokines and chemokines that provide a permissive microenvironment for tumor growth. Research into specific biomarkers and signaling pathways of malignant lymphomas might therefore result in the identification of novel targets for future therapeutic strategies. As gene expression profiling techniques are not yet feasible in the clinical laboratory, studies have aimed to translate the findings into more widely applicable techniques that might allow this research to be applied to routine clinical practice. This review focuses on recent advances in translational and clinical research on biomarkers in malignant lymphomas.