Follicular Large Cell Lymphoma: An Aggressive Lymphoma That Often Presents With Favorable Prognostic Features

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.

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

“…An analysis of the aggregated numbers from these four studies shows a gender difference: women represented 218/397 (55%) of grade 3A and 50/117 (43%) of grade 3B patients (P = 0AE020). Furthermore, patients with grade 3B had less bone-marrow and stage III-IV disease, as previously shown in entities of older nomenclatures corresponding to grade 3B (Miller et al, 1997;Rodriguez et al, 1999). In our study, 44% of grade 1-3A and 17% of grade 3B patients showed bone-marrow involvement; the reported frequency in DLBCL is 17% (The Non-Hodgkin's Lymphoma Classification Project., 1997).…”

“…It is composed of small centrocytes and large centroblasts residing in follicles that also harbour nonmalignant immune cells. Follicular lymphoma is morphologically graded, the value of which has been debated since the 1980s (Gallagher et al, 1986;Horning et al, 1987;Anderson et al, 1993;Bartlett et al, 1994;Martin et al, 1995;Miller et al, 1997;Wendum et al, 1997;Rodriguez et al, 1999;Chau et al, 2003;Hans et al, 2003;Hsi et al, 2004;Ganti et al, 2006;Klapper et al, 2007;Harris et al, 2008;Piccaluga et al, 2008;Shustik et al, 2011). Based on the number of centroblasts, the World Health Organization (WHO) classification divides follicular lymphoma into grades 1, 2, and 3 (Harris et al, 2008).…”

Canine Indolent Nodular Lymphoma

“…Follicular-derived lymphomas frequently develop in the presence of germinal centers that may be involuting to “fading” follicles. 22, 28, 38, 44 Involution of germinal centers may result in collapse of the mantle cells into the follicular dendritic cell center, with the formation of clusters of small dense cells in place of the original germinal centers (see late MZL). This is called fading follicular hyperplasia (FFH).…”

Bendamustine plus Rituximab Versus R-CHOP as First-Line Treatment for Patients with Follicular Lymphoma Grade 3A: Evidence from a Multicenter, Retrospective Study

“…FL grades 1 and 2 are characterized by an indolent clinical course [1], whereas, in the prerituximab era, FL3 commonly led to worse overall survival [9][10][11][12]. Some authors suggested that anthracycline-containing chemotherapy might improve outcomes for this more aggressive subgroup [9][10][11][13][14][15][16][17][18][19]. After the introduction of rituximab into clinical routine, immunochemotherapy regimens, such as rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP), were considered the standard of care for first-line treatment of patients with symptomatic advanced FL [20][21][22].…”