title: Peripheral blood involvement in patients with follicular lymphoma: a rare disease manifestation associated with poor prognosis.
abstract: Follicular Lymphoma (FL) is the second most common non-Hodgkin lymphoma (NHL) subtype and its course is heterogeneous. At diagnosis, some patients with FL manifest a detectable leukaemic phase (FL-LP), but this feature has been seldom described and is poorly characterized. Among 499 patients diagnosed with FL in Lyon-Sud hospital, 37 (7·4%) had characteristic FL-LP (by cytological blood smears and flow cytometric analysis). In addition, 91/1135 FL patients from the PRIMA study presented FL-LP at study entry. In order to evaluate the outcome of this Lyon-Sud cohort, FL-LP patients were matched with 111 newly diagnosed FL without LP according to the Follicular Lymphoma International Prognostic Index (FLIPI) score, age and treatment. Presence of FL-LP was associated with shorter progression-free survival (PFS) and overall survival (OS) (P = 0·004 and P = 0·031, respectively). Presence of FL-LP and high FLIPI score remained independent prognostic factors in a Cox model for time to progression (TTP). A number of circulating lymphoma cells (CLC) >4 × 10(9) /l was the most significant predictor for a shorter TTP in this Cox model. The prognostic impact of FL-LP on TTP was validated in the PRIMA cohort (P = 0·0004). In conclusion, FL-LP is a rare event associated with shorter PFS and patients with CLC >4 × 10(9) /l have a poorer outcome. These patients should be monitored carefully to consider alternative therapeutic options.
authors.affiliation: Hospices Civils de Lyon (HCL), Service d'Hématologie, Centre Hospitalier Lyon Sud (CHLS), Pierre Benite Cedex, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Sarkozy
authors.forename: Lucile
authors.initials: L
authors.lastname: Baseggio
authors.forename: Pierre
authors.initials: P
authors.lastname: Feugier
authors.forename: Evelyne
authors.initials: E
authors.lastname: Callet-Bauchu
authors.forename: Lionel
authors.initials: L
authors.lastname: Karlin
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.forename: Laure
authors.initials: L
authors.lastname: Lebras
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Michallet
authors.forename: Fritz
authors.initials: F
authors.lastname: Offner
authors.forename: Olivier
authors.initials: O
authors.lastname: Dumas
authors.forename: Alexandra
authors.initials: A
authors.lastname: Traverse-Glehen
authors.forename: Martine
authors.initials: M
authors.lastname: Ffrench
authors.forename: Armando
authors.initials: A
authors.lastname: Lopez-Guillermo
authors.forename: Françoise
authors.initials: F
authors.lastname: Berger
authors.forename: Bertrand
authors.initials: B
authors.lastname: Coiffier
authors.forename: Pascale
authors.initials: P
authors.lastname: Felman
authors.forename: Gilles
authors.initials: G
authors.lastname: Salles
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D007964:Leukocytosis / Q000209:etiology*; D008224:Lymphoma, Follicular / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011379:Prognosis; D035583:Rare Diseases / Q000209:etiology; D012189:Retrospective Studies; D000069283:Rituximab; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: follicular lymphoma; peripheral blood involvement; prognostic factor; rituximab maintenance