Gene expression profiling in follicular lymphoma to assess clinical aggressiveness and to guide the choice of treatment.
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.
Glas
Annuska M
AM
Netherlands Cancer Institute, Division of Diagnostic Oncology, Central Microarray Facility, Amsterdam, The Netherlands.
Kersten
Marie José
MJ
Delahaye
Leonie J M J
LJ
Witteveen
Anke T
AT
Kibbelaar
Robby E
RE
Velds
Arno
A
Wessels
Lodewyk F A
LF
Joosten
Peter
P
Kerkhoven
Ron M
RM
Bernards
René
R
van Krieken
Johan H J M
JH
Kluin
Philip M
PM
van't Veer
Laura J
LJ
de Jong
Daphne
D
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
D009363:Neoplasm Proteins