Zha Jie, Chen Qinwei, Ye Jingjing, Yu Haifeng, Yi Shuhua, Zheng Zhong, Xu Wei, Li Zhifeng, Ping Lingyan, He Xiaohua, Zhang Liling, Li Caixia, Xie Ying, Chen Feili, Sun Xiuhua, Su Liping, Zhang Huilai, Fan Liyuan, Lin Zhijuan, Yang Haiyan, Zhao Weili, Qiu Lugui, Li Zhiming, Song Yuqin, Xu Bing
Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, 361003, P.R, China.
Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China.
Biomark Res. 2023 Feb 6;11(1):16. doi: 10.1186/s40364-023-00462-z.
The difference between clinical characteristics and outcomes between follicular lymphoma grade 1-2 (FL1-2) and FL3a defined pathologically remains unclear, resulting in uncertainty how to treat FL3a. However, it may be crucial for clinicians to discriminate grade 3a and grade 1-2 for predicting prognosis and thus making treatment decisions.
We compared 1403 patients with FL1-2 and 765 patients with FL3a diagnosed between January 2000 and December 2020 from fifteen centers nationwide in China to describe differences in clinical characteristics and outcomes.
Compared with FL1-2 patients, FL3a subgroup had a higher percentage of elderly patients (P = 0.003), and relatively more FL3a patients presented with increased levels of LDH (P < 0.0001) and higher Ki-67 indexs greater than 30% (P < 0.001). More FL3a patients were treated with CHOP ± R (P < 0.0001), and fewer were treated with the watchful-waiting approach (P < 0.0001). The results showed a higher incidence of relapse among FL3a patients, in which more patients underwent histological transformation (HT) when compared to FL1-2 (P = 0.003). 1470 (76.2%) patients of the entire cohort received R-CHOP therapy; survival analysis revealed that FL3a patients had a worse progression-free survival (PFS) rate than FL1-2 patients. Survival of FL3a patients with respect to FLIPI showed an inferior PFS in the intermediate and high-risk groups than FL1-2 patients. FL3a patients had a much worse prognosis than FL1-2 with or without progression of disease within 24 months (POD24). FL3a patients had higher likelihood of lymphoma-related death (LRD, P < 0.05), whereas the rates for non-LRD were comparable.
In conclusion, this study demonstrates a marked difference in clinical features and outcomes in FL3a patients compared with FL1-2 patients. The results highlight the need for applying therapeutic approaches distinct from FL1-2 when treating FL3a patients.
滤泡性淋巴瘤1-2级（FL1-2）与病理定义的FL3a在临床特征和预后方面的差异尚不清楚，这导致在如何治疗FL3a方面存在不确定性。然而，对于临床医生来说，区分3a级和1-2级对于预测预后从而做出治疗决策可能至关重要。
我们比较了2000年1月至2020年12月期间在中国全国15个中心诊断的1403例FL1-2患者和765例FL3a患者，以描述临床特征和预后的差异。
与FL1-2患者相比，FL3a亚组老年患者的比例更高（P = 0.003），相对更多的FL3a患者乳酸脱氢酶（LDH）水平升高（P < 0.0001），且Ki-67指数大于30%的患者更多（P < 0.001）。更多的FL3a患者接受CHOP±R治疗（P < 0.0001），而采用观察等待方法治疗的患者较少（P < 0.0001）。结果显示FL3a患者的复发率更高，与FL1-2相比，更多患者发生组织学转化（HT）（P = 0.003）。整个队列中的1470例（76.2%）患者接受了R-CHOP治疗；生存分析显示，FL3a患者的无进展生存期（PFS）率低于FL1-2患者。FL3a患者在国际预后指数（FLIPI）的中危和高危组中的PFS低于FL1-2患者。无论疾病在24个月内有无进展（POD24），FL3a患者的预后均比FL1-2患者差得多。FL3a患者发生淋巴瘤相关死亡（LRD）的可能性更高（P < 0.05），而非LRD的发生率相当。
总之，本研究表明FL3a患者与FL1-2患者在临床特征和预后方面存在显著差异。结果强调在治疗FL3a患者时需要采用与FL1-2不同的治疗方法。
