Nodular poorly differentiated lymphocytic lymphoma: changes in histology and survival.

Lymphoma patients with a nodular pattern have a better prognosis than those with a diffuse pattern. Histologic evolution from nodular to diffuse may occur during the course of the disease in the same patient. This change in pattern may be of prognostic significance. We reviewed 56 patients with an initial diagnosis of nodular poorly differentiated lymphoma seen over a 12-year period (1966-1978). Thirty-five patients had biopsies after initial diagnosis, and 28 of the cases could be classified as nodular or diffuse. Eleven of the 56 cases evolved from a nodular to a diffuse pattern. Forty-four of the 56 patients achieved a complete remission and were evaluated for survival. The median survival (66+ months) for patients who have never relapsed is similar to that for patients who relapsed with a nodular pattern (70 months) and patients who relapsed with a diffuse pattern (73 months). Relapse with a nodular pattern occurred at a median of 27 months after initial diagnosis and relapse with a diffuse pattern (73 months). Relapse with a nodular pattern occurred at a median of 27 months after initial diagnosis and relapse with a diffuse pattern occurred at a median of 49 months. Although overall survival in patients relapsing with nodular or diffuse disease is similar, median survival from relapse with nodular disease is longer (32+ months) than median survival with diffuse disease (17 months) (P = 0.068).