Follicular non-Hodgkin's lymphoma: correlation between histology, pathophysiology, cytogenetic, prognostic factors, treatment, survival.

BACKGROUND

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.

AIM OF STUDY

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.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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.