Clinical significance of the WHO grades of follicular lymphoma in a population‐based cohort of 505 patients with long follow‐up times

Abstract

SummaryThe prognostic value of grading follicular lymphoma has been debated since the 1980s. There is consensus that World Health Organization (WHO) grades 1 and 2 are indolent, but not whether grades 3A or 3B are aggressive. We retrospectively reviewed the follicular lymphoma diagnoses according to the 2008 WHO classification in all diagnostic specimens from a population-based cohort of 505 patients with a median follow-up time of 10AE0 years (range, 4AE6-16AE0). After excluding 43 patients with concomitant diffuse large B-cell lymphoma, 345 remained with grade 1-2, 94 with grade 3A, and 23 with grade 3B follicular lymphoma. Grades 1-2 and 3A seemed equally indolent, with indistinguishable clinical courses, even in patients receiving anthracyclines. Compared with grades 1-3A and independently of clinical factors, grade 3B correlated with higher mortality (P = 0AE008), but outcome was improved after upfront anthracycline-containing therapy (P = 0AE015). In contrast to grade 1-3A patients, grade 3B patients experienced no relapses or deaths beyond 5 years of follow-up. Furthermore, patients with grade 3B were predominantly male and seldom presented with bone-marrow involvement. We conclude that follicular lymphoma grade 1-3A is indolent and incurable with conventional therapy. Grade 3B appears to be an aggressive but curable disease.

Follicular lymphoma in young adults: a clinicopathological and molecular study of 200 patients

“…Only grade 3B cases showed significant worsening of overall survival. This is in accordance with a recent study by Wahlin et al, 26 who evaluated a population-based cohort of 505 follicular lymphoma patients in a broad age range (25-89 years) and found that grade 3A follicular lymphoma behaved like an indolent lymphoma. Others have confirmed similar findings.…”

The role of autologous and allogeneic stem cell transplantation in the management of indolent B-cell lymphoma

“…This point is relevant because the standard management of aggressive NHL would be ASCT (not allo-SCT) in the setting of chemotherapy-sensitive relapsed or refractory disease. [32][33][34] Comparative data regarding the grade of FL or the outcome of other subtypes of iNHL with SCT are limited. 35,36 Older reviews have reported conflicting reviews, with 2 of 3 relevant series reporting results from the pre-rituximab era.…”

The miR-17-92 microRNA cluster: a novel diagnostic tool in large B-cell malignancies

“…8 More recently, some authors are proposing to consider the 3a group as an indolent BCL and the 3b as clinically similar to DLBCL, but conflicting data have been published. 8 In fact, in contrast to DLBCL, the relapse rate of grade 3b FL is in some series higher and survival is longer.…”

“…8 More recently, some authors are proposing to consider the 3a group as an indolent BCL and the 3b as clinically similar to DLBCL, but conflicting data have been published. 8 In fact, in contrast to DLBCL, the relapse rate of grade 3b FL is in some series higher and survival is longer. 9,10,45 Moreover, several reports have found no difference in outcome between FL grades 3a and 3b when treated with anthracycline-based therapy, and molecular studies identified comparable gene expression profiles between FL grade 3a and FL grade 3b.…”