title: Gene expression profiling in follicular lymphoma to assess clinical aggressiveness and to guide the choice of treatment.
abstract: Follicular lymphoma (FL) is a disease characterized by a long clinical course marked by frequent relapses that vary in clinical aggressiveness over time. Therefore, the main dilemma at each relapse is the choice for the most effective treatment for optimal disease control and failure-free survival while at the same time avoiding overtreatment and harmful side effects. The selection for more aggressive treatment is currently based on histologic grading and clinical criteria; however, in up to 30% of all cases these methods prove to be insufficient. Using supervised classification on a training set of paired samples from patients who experienced either an indolent or aggressive disease course, a gene expression profile of 81 genes was established that could, with an accuracy of 100%, distinguish low-grade from high-grade disease. This profile accurately classified 93% of the FL samples in an independent validation set. Most important, in a third series of FL cases where histologic grading was ambiguous, precluding meaningful morphologic guidance, the 81-gene profile shows a classification accuracy of 94%. The FL stratification profile is a more reliable marker of clinical behavior than the currently used histologic grading and clinical criteria and may provide an important alternative to guide the choice of therapy in patients with FL both at presentation and at relapse.
authors.affiliation: Netherlands Cancer Institute, Division of Diagnostic Oncology, Central Microarray Facility, Amsterdam, The Netherlands.
authors.forename: Annuska M
authors.initials: AM
authors.lastname: Glas
authors.forename: Marie José
authors.initials: MJ
authors.lastname: Kersten
authors.forename: Leonie J M J
authors.initials: LJ
authors.lastname: Delahaye
authors.forename: Anke T
authors.initials: AT
authors.lastname: Witteveen
authors.forename: Robby E
authors.initials: RE
authors.lastname: Kibbelaar
authors.forename: Arno
authors.initials: A
authors.lastname: Velds
authors.forename: Lodewyk F A
authors.initials: LF
authors.lastname: Wessels
authors.forename: Peter
authors.initials: P
authors.lastname: Joosten
authors.forename: Ron M
authors.initials: RM
authors.lastname: Kerkhoven
authors.forename: René
authors.initials: R
authors.lastname: Bernards
authors.forename: Johan H J M
authors.initials: JH
authors.lastname: van Krieken
authors.forename: Philip M
authors.initials: PM
authors.lastname: Kluin
authors.forename: Laura J
authors.initials: LJ
authors.lastname: van't Veer
authors.forename: Daphne
authors.initials: D
authors.lastname: de Jong
mesh_terms: D000328:Adult; D000368:Aged; D020869:Gene Expression Profiling; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008224:Lymphoma, Follicular / Q000145:classification / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000235:genetics; D011379:Prognosis; D012008:Recurrence; D015203:Reproducibility of Results
chemical_list: D009363:Neoplasm Proteins