Follicular non-Hodgkin lymphoma grades 3A and 3B have a similar outcome and appear incurable with anthracycline-based therapy.
BACKGROUND
The revised World Health Organization (WHO) classification maintains a histological grading system (grades 1-3) for follicular lymphoma (FL) and subdivides grade 3 into 3A (FL3A) and 3B (FL3B) subtypes. Optimal therapy of FL grade 3 and its potential curability with anthracycline-based chemotherapy remain uncertain.


METHODS
We carried out a retrospective population-based analysis evaluating the clinical characteristics and outcome of FL3A and FL3B as strictly defined by WHO diagnostic criteria. Using the BC Cancer Agency Lymphoid Cancer Database, 161 patients with FL grade 3 were identified and, following detailed pathology review, composed of 139 with FL3A and 22 with FL3B.


RESULTS
Patients with FL3B had a higher overall International Prognostic Index (IPI) score than FL3A patients (P = 0.03), though no significant difference in individual IPI risk factor frequencies was noted. More patients with FL3B received front-line anthracycline-containing chemotherapy (82% versus 36%, P ≤ 0.001). With median follow-up of 45 months, no difference in disease-specific survival (P = 0.74) or overall survival (OS) (P = 0.87) was found between FL3A and FL3B and no survival curve plateau was observed. Analysis limited to FL3A patients showed no OS advantage with front-line anthracycline use (P = 0.33).


CONCLUSIONS
Using strict diagnostic criteria, there appears to be no difference in outcome between patients with FL3A and FL3B and no evidence of curability with anthracycline-based therapy.
Centre for Lymphoid Cancers. Electronic address: jshustik@bccancer.bc.ca.
J
J
Shustik
Centre for Lymphoid Cancers.
M
M
Quinn
Centre for Lymphoid Cancers.
J M
JM
Connors
Department of Pathology and Laboratory Medicine of the BC Cancer Agency and the University of British Columbia, Vancouver, Canada.
R D
RD
Gascoyne
Department of Pathology and Laboratory Medicine of the BC Cancer Agency and the University of British Columbia, Vancouver, Canada.
B
B
Skinnider
Centre for Lymphoid Cancers.
L H
LH
Sehn
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
D018943:Anthracyclines; D000970:Antineoplastic Agents