Multicenter Analysis of Advanced Stage Grade 3A Follicular Lymphoma Outcomes by Frontline Treatment Regimen

Shah, Nirav N.; Szabó, Anikó; Saba, Raya; Strelec, Lauren E.; Kodali, Dheeraj; Vaughn, John; Esan, Olukemi; Yang, David T.; Mato, Anthony R.; Kanate, Abraham S.; Olteanu, Horatiu; Hamadani, Mehdi; Fenske, Timothy S.; Kenkre, Vaishalee P.; Svoboda, Jakub; Cashen, Amanda F.; Epperla, Narendranath

doi:10.1016/j.clml.2018.11.010

Cited by 11 publications

(10 citation statements)

References 26 publications

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“…These results were reproduced in the small group of patients (n = 27) that received anthracycline‐containing regimens as first‐line therapy. A recent study in United States analysed grade 3A FL patients (n = 103) treated with (n = 65) or without (n = 8) anthracyclines and bendamustine (n = 30). TTF, PFS and OS showed no differences between anthracyclines chemotherapy and bendamustine‐containing regimens.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcome comparing histological grades of follicular lymphoma patients treated with immunochemotherapy as first‐line therapy: A retrospective analysis from two institutions

Mercadal

Sancho

Climent

et al. 2019

European J of Haematology

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Objectives To clarify the impact of histological grades in follicular lymphoma. Methods We retrospectively analysed 250 patients diagnosed with FL treated with chemoimmunotherapy: 188 patients were grades 1‐2 and 62 grade 3A. Results In our series, grade 3A FL patients were older, higher proportion of localised disease and lower bone marrow infiltration at diagnosis comparing grades 1‐2 FL patients. Estimated six‐year progression‐free survival and time to progression showed no differences between both groups [grade 3A: 56% (95%CI: 39%‐73%) and 51% (95%CI: 41%‐61%) vs grades 1‐2:55% (95%CI: 46%‐63%) and 57% (95%CI: 49%‐65%), P = .782 and P = .521, respectively]. Estimated six‐year overall survival was lower, 76% (95%CI: 64%‐88%) for the grade 3A group than grades 1‐2 83% (95%CI: 77%‐89%); P = .044. In addition to that, cumulative incidence curves of death not related to lymphoma at 10 years between groups were as follows: [0.26 (95%CI: 0.25‐0.27) and 0.05 (95%CI: 0.04‐0.06) for G3AFL and G1‐2FL, respectively], P = .010. Grade 3A FL showed in PFS curve no relapses after 6 years. These results were absolutely reproduced in 199 patients receiving R‐CHOP regimen as induction. Conclusions Our results indicate similar long‐term outcomes in terms of progression‐free survival and time to progression in grades 1‐2 and 3A. No relapses were observed in G3AFL group after 6 years.

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Section: Discussionmentioning

confidence: 99%

“…However, the approach and survival of grade 3A FL (G3AFL) remain unclear and few data exist on the specific outcome of this precise histology since the introduction of rituximab. Some studies suggest a pattern of continuous relapses, and others suggest a plateau in survival curves in these G3AFL patients.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcome comparing histological grades of follicular lymphoma patients treated with immunochemotherapy as first‐line therapy: A retrospective analysis from two institutions

Mercadal

Sancho

Climent

et al. 2019

European J of Haematology

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“…In the ICC, the consensus was to retain the morphological grading of FL, as defined in the WHO-HAEM4, although it remains unclear whether clinically the grade 3A differs from grades 1 and 2 [ 60 ]. Conversely, patients with grade 3B FL are usually treated as DLBCL [ 61 , 62 ].…”

Section: Mature B-cell Neoplasmsmentioning

confidence: 99%

A comparison of the International Consensus and 5th World Health Organization classifications of mature B-cell lymphomas

2022

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Several editions of the World Health Organization (WHO) classifications of lympho-hemopoietic neoplasms in 2001, 2008 and 2017 served as the international standard for diagnosis. Since the 4th WHO edition, here referred as WHO-HAEM4, significant clinico-pathological, immunophenotypic and molecular advances have been made in the field of lymphomas, contributing to refining diagnostic criteria of several diseases, to upgrade entities previously defined as provisional and to identify new entities. This process has resulted in two recent classifying proposals of lymphoid neoplasms, the International Consensus Classification (ICC) and the 5th edition of the WHO classification (WHO-HAEM5). In this paper, we review and compare the two classifications in terms of diagnostic criteria and entity definition, with focus on mature B-cell neoplasms. The main aim is to provide a tool to facilitate the work of pathologists, hematologists and researchers involved in the diagnosis and treatment of lymphomas.

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“…Grades 1 and 2 are considered as indolent (slow-growing), whereas grade 3B has an aggressive course and is managed as diffuse large B-cell lymphoma (DLBCL) ( 4 , 5 ). However, the optimal treatment for grade 3A FL is controversial ( 6 , 7 ). Grade 3A FL has been suggested to be on the same continuum as grades 1 and 2 ( 8 ), and the contrasting findings revealed that gene expression profiling demonstrates a close relationship between FL 3A and 3B, but distinct from grades 1 and 2 ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Prediction of prognosis and pathologic grade in follicular lymphoma using 18F-FDG PET/CT

Wang

Fan

et al. 2022

Front. Oncol.

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PurposeWe investigated the utility of a new baseline PET parameter expressing lesion dissemination and metabolic parameters for predicting progression-free survival (PFS) and pathologic grade in follicular lymphoma (FL).MethodsThe baseline 18F-FDG PET/CT images of 126 patients with grade 1–3A FL were retrospectively analyzed. A novel PET/CT parameter characterizing lesion dissemination, the distance between two lesions that were furthest apart (Dmax), was calculated. The total metabolic tumor volume and total lesion glycolysis (TLG) were computed by using 41% of the maximum standardized uptake value (SUVmax) thresholding method.ResultsThe 5-year PFS rate was 51.9% for all patients. In the multivariate analysis, high Dmax [P = 0.046; hazard ratio (HR) = 2.877], high TLG (P = 0.004; HR = 3.612), and elevated serum lactate dehydrogenase (P = 0.041; HR = 2.287) were independent predictors of PFS. A scoring system for prognostic stratification was established based on these three adverse factors, and the patients were classified into three risk categories: low risk (zero to one factor, n = 75), intermediate risk (two adverse factors, n = 29), and high risk (three adverse factors, n = 22). Patients in the high-risk group had a shorter 3-year PFS (21.7%) than those in the low- and intermediate-risk groups (90.6 and 44.6%, respectively) (P < 0.001). The C-index of our scoring system for PFS (0.785) was superior to the predictive capability of the Follicular Lymphoma International Prognostic Index (FLIPI), FLIPI2, and PRIMA-Prognostic Index (C-index: 0.628–0.701). The receiver operating characteristic curves and decision curve analysis demonstrated that the scoring system had better differentiation and clinical utility than these existing indices. In addition, the median SUVmax was significantly higher in grade 3A (36 cases) than in grades 1 and 2 FL (90 cases) (median: 13.63 vs. 11.45, P = 0.013), but a substantial overlap existed (range: 2.25–39.62 vs. 3.17–39.80).ConclusionTLG and Dmax represent two complementary aspects of the disease, capturing the tumor burden and lesion dissemination. TLG and Dmax are promising metrics for identifying patients at a high risk of progression or relapse. Additionally, SUVmax seems to have some value for distinguishing grade 3A from low-grade FL but cannot substitute for biopsy.

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Multicenter Analysis of Advanced Stage Grade 3A Follicular Lymphoma Outcomes by Frontline Treatment Regimen

Cited by 11 publications

References 26 publications

Long‐term outcome comparing histological grades of follicular lymphoma patients treated with immunochemotherapy as first‐line therapy: A retrospective analysis from two institutions

Long‐term outcome comparing histological grades of follicular lymphoma patients treated with immunochemotherapy as first‐line therapy: A retrospective analysis from two institutions

A comparison of the International Consensus and 5th World Health Organization classifications of mature B-cell lymphomas

Prediction of prognosis and pathologic grade in follicular lymphoma using 18F-FDG PET/CT

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