Găman Amelia Maria
Department of Pathophysiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania.
Rom J Morphol Embryol. 2013;54(1):71-6.
Folicullar lymphoma (FL) is one of the most common types of all non-Hodgkin's lymphomas (25-40%), characterized by a slowly progressive enlargement of lymph nodes, impairment of hematopoiesis, increased risk to infections, a relatively good prognosis, but usually incurable. Histopathologically, FL has been graded according to the proportion of centroblasts and stratified into grades 1-3: FL grade 1-2 (low-grade), which include cases with few centroblasts, and FL grade 3, divided into grades 3a and 3b, based on the absence of centrocytes in the latter category. Several studies have identified some differences between grade 3a and grade 3b of FL, with most cases of FL grade 3b being more closely related to diffuse large B-cell lymphoma (DLBCL) at molecular level. Several multicenter prospective randomized trials demonstrated an improved outcome when Rituximab (R) was added to chemotherapy for the treatment of follicular non-Hodgkin's lymphomas and a beneficial effect in the quality of life after Rituximab maintenance therapy at these patients.
To establish some correlation between histology, prognostic factors, treatment and evaluate whether maintenance therapy with anti-CD20+ monoclonal antibodies prolonged progression free survival compared to observation only at the patients with follicular lymphomas treated with R-chemotherapy regimens.
We studied nineteen patients with follicular non-Hodgkin's lymphomas (grades 1-3) treated with R-CHOP/R-miniCHOP regimens hospitalized in the Clinic of Hematology from Craiova (Romania), between 2008-2011. After these treatments, nine patients with stage III/IV follicular lymphomas were treated with Rituximab maintenance therapy (eight cycles Rituximab 375 mg/m(2), i.v., once every three months for two years) vs. observation only at 10 patients.
In our study, low-grade FL was correlated with a good prognosis at patients with FLIPI score 0-2; the statistical analysis revealed that the progression free survival (PFS) was prolonged at the patients with stage III/IV follicular lymphomas who received Rituximab maintenance therapy compared to the ones with observation only with 1.9 years.
Low-grade (1-2) FL was correlated with a good prognosis in patients with FLIPI score 0-2; Rituximab maintenance therapy compared with observation only is safe and prolonged progression free survival at patients with follicular lymphomas treated with R-chemotherapy as first line therapy.
滤泡性淋巴瘤（FL）是所有非霍奇金淋巴瘤中最常见的类型之一（占25%-40%），其特征为淋巴结缓慢进行性肿大、造血功能受损、感染风险增加、预后相对较好，但通常无法治愈。在组织病理学上，FL根据中心母细胞的比例进行分级，分为1-3级：FL 1-2级（低级别），包括中心母细胞数量少的病例；FL 3级，又分为3a级和3b级，后者基于无中心细胞。多项研究已确定FL 3a级和3b级之间存在一些差异，大多数FL 3b级病例在分子水平上与弥漫性大B细胞淋巴瘤（DLBCL）关系更为密切。多项多中心前瞻性随机试验表明，在滤泡性非霍奇金淋巴瘤化疗中加入利妥昔单抗（R）可改善疗效，且利妥昔单抗维持治疗对这些患者的生活质量有有益影响。
建立组织学、预后因素与治疗之间的一些相关性，并评估与仅观察相比，抗CD20+单克隆抗体维持治疗是否能延长接受R-化疗方案治疗的滤泡性淋巴瘤患者的无进展生存期。
我们研究了2008年至2011年间在罗马尼亚克拉约瓦血液学诊所住院的19例接受R-CHOP/R-迷你CHOP方案治疗的滤泡性非霍奇金淋巴瘤（1-3级）患者。这些治疗后，9例III/IV期滤泡性淋巴瘤患者接受利妥昔单抗维持治疗（8个周期，利妥昔单抗375mg/m²，静脉注射，每三个月一次，共两年），而10例患者仅接受观察。
在我们的研究中，低级别FL与FLIPI评分为0-2的患者的良好预后相关；统计分析显示，接受利妥昔单抗维持治疗的III/IV期滤泡性淋巴瘤患者的无进展生存期（PFS）比仅接受观察的患者延长了1.9年。
低级别（1-2级）FL与FLIPI评分为0-2的患者的良好预后相关；与仅观察相比，利妥昔单抗维持治疗对接受R-化疗作为一线治疗的滤泡性淋巴瘤患者是安全的，并能延长无进展生存期。
