Mustafa Ali Moaath, Rybicki Lisa, Nomani Laila, Rouphail Basel, Dean Robert M, Hill Brian T, Jagadeesh Deepa, Pohlman Brad, Hsi Eric D, Smith Mitchell R
Internal Medicine, Cleveland Clinic, Cleveland, OH.
Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH.
Clin Lymphoma Myeloma Leuk. 2017 Dec;17(12):797-803. doi: 10.1016/j.clml.2017.07.002. Epub 2017 Jul 13.
Follicular lymphoma (FL) is heterogeneous. Although FL Grade 3B (FL3B) is treated as aggressive FL (aggFL), an optimal approach to FL Grade 3A (FL3A) remains unclear because few data exist on clinical outcomes on the basis of subclassification of FL Grade 3 (FL3) since the introduction of rituximab. We report outcomes of FL3 in the rituximab era.
We identified and analyzed a retrospective cohort of 53 patients with FL3A, 3B, and FL Grade 3 with areas of diffuse large B-cell lymphoma (DLBCL). They were divided into 2 groups: aggFL (n = 21) included patients with FL3B (n = 10) and FL3 (A or B) with concomitant DLBCL (n = 11); indolent lymphoma (n = 32) included only FL3A.
Baseline characteristics did not differ between the groups. rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) was initial treatment in 15 (79%) of patients with aggFL and 21 (72%) of those with FL3A; rituximab was included in initial therapy in 18 (95%) and 24 (83%), respectively. Comparing aggFL and FL3A, 5-year overall survival was 90% versus 79% (P = .97) and 5-year progression-free survival (PFS) 44% versus 34% (P = .75), respectively.
We conclude that outcomes for FL3, primarily treated with R-CHOP, do not differ between FL3A and aggFL (FL3B and FL3/DLBCL). The aggFL group showed a plateau in PFS confirming these should be treated with curative intent. FL3A patients, mainly managed with R-CHOP, also show an apparent plateau in PFS. Although longer follow-up and confirmation in other data sets is required, this indicates potential undertreatment of FL3A with less aggressive regimens often used for indolent lymphoma.
滤泡性淋巴瘤（FL）具有异质性。尽管FL 3B级（FL3B）被视为侵袭性FL（aggFL），但由于自利妥昔单抗应用以来，基于FL 3级（FL3）亚分类的临床结局数据较少，FL 3A级（FL3A）的最佳治疗方法仍不明确。我们报告了利妥昔单抗时代FL3的结局。
我们确定并分析了53例FL3A、FL3B以及伴有弥漫性大B细胞淋巴瘤（DLBCL）区域的FL 3级患者的回顾性队列。他们被分为两组：侵袭性FL（n = 21）包括FL3B患者（n = 10）以及伴有DLBCL的FL3（A或B）患者（n = 11）；惰性淋巴瘤（n = 32）仅包括FL3A患者。
两组的基线特征无差异。利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松（R-CHOP）是15例（79%）侵袭性FL患者和21例（占72%）FL3A患者的初始治疗方案；初始治疗中分别有18例（95%）和24例（83%）包含利妥昔单抗。比较侵袭性FL和FL3A，5年总生存率分别为90%和79%（P = 0.97），5年无进展生存率分别为44%和34%（P = 0.75）。
我们得出结论，主要采用R-CHOP治疗的FL3患者，FL3A和侵袭性FL（FL3B和FL3/DLBCL）之间的结局无差异。侵袭性FL组的无进展生存率出现平台期，证实这些患者应以治愈为目的进行治疗。主要采用R-CHOP治疗的FL3A患者的无进展生存率也出现明显的平台期。尽管需要更长时间的随访并在其他数据集中进行确认，但这表明FL3A患者可能未得到充分治疗，因为常用于惰性淋巴瘤的治疗方案攻击性较弱。
