title: Follicular large-cell lymphoma treated with intensive chemotherapy: an analysis of 89 cases included in the LNH87 trial and comparison with the outcome of diffuse large B-cell lymphoma. Groupe d'Etude des Lymphomes de l'Adulte.
abstract: OBJECTIVE
  The aims of this study were as follows: (1) to analyze clinical, histopathologic characteristics, treatment outcome, and prognostic factors of patients with follicular large-cell lymphoma (FLCL); and (2) to compare them with those of patients with diffuse large B-cell lymphoma (DLCL) treated in the same therapeutic trial.
  
  
  METHODS
  Eighty-nine FLCL patients who were histologically reviewed and who received an intensive chemotherapy regimen according to the LNH 87 protocol were analyzed and compared with 1,096 B-cell DLCL patients included in the same protocol.
  
  
  RESULTS
  After intensive induction treatment, 59 patients (67%) achieved a complete remission [CR]. Estimated 5-year survival was 59%, and estimated 5-year freedom from progression (FFP) was 39%. Prognostic factors associated with shorter FFP were age greater than 60 years (P = .02), advanced clinical stage (P = .01), abnormal lactic dehydrogenase (LDH) level (P = .02), abnormal beta-2 microglobulin (P = .02), B symptoms (P = .03), bone marrow involvement (P = .04), and high expression of bcl-2 protein (P = .05). When compared with B-cell DLCL patients, FLCL patients were younger (P = .02), had a better Eastern Cooperative Oncology Group (ECOG) status (P = .05), less bulky mass (P = .04), more advanced clinical stages (P < .001), and more bone marrow involvement (P = .02). No significant difference was observed between FLCL and DLCL patients for response to therapy (67% v 67% of CR), 5-year overall survival (58% v 51%), 5-year disease-free survival (53% v 57%), or FFP survival (39% v 43%).
  
  
  CONCLUSIONS
  FLCL patients have a favorable response rate and survival when treated with intensive chemotherapy. Their outcome is similar to that of B-cell DLCL patients, and a long-term FFP is observed for a substantial number of patients. Some adverse prognostic factors (including those of the International Prognostic Index, bone marrow involvement, and beta-2 microglobulin) have been identified to define a subset of patients who require other therapeutic approach.
authors.affiliation: Services d'Anatomie et Cytologie Pathologiques, Hôpital Saint-Antoine, Pessac, France.
authors.forename: D
authors.initials: D
authors.lastname: Wendum
authors.forename: C
authors.initials: C
authors.lastname: Sebban
authors.forename: P
authors.initials: P
authors.lastname: Gaulard
authors.forename: B
authors.initials: B
authors.lastname: Coiffier
authors.forename: H
authors.initials: H
authors.lastname: Tilly
authors.forename: D
authors.initials: D
authors.lastname: Cazals
authors.forename: A
authors.initials: A
authors.lastname: Boehn
authors.forename: R O
authors.initials: RO
authors.lastname: Casasnovas
authors.forename: R
authors.initials: R
authors.lastname: Bouabdallah
authors.forename: J
authors.initials: J
authors.lastname: Jaubert
authors.forename: A
authors.initials: A
authors.lastname: Ferrant
authors.forename: J
authors.initials: J
authors.lastname: Diebold
authors.forename: A
authors.initials: A
authors.lastname: de Mascarel
authors.forename: C
authors.initials: C
authors.lastname: Gisselbrecht
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008224:Lymphoma, Follicular / Q000737:chemistry / Q000188:drug therapy* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000737:chemistry / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000032:analysis; D012074:Remission Induction; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D019253:Proto-Oncogene Proteins c-bcl-2