Differences in clinical characteristics and outcomes between patients with grade 3a and grades 1-2 follicular lymphoma: a real-world multicenter study

Jie Zha; Qinwei Chen; Jingjing Ye; Haifeng Yu; Shuhua Yi; Zhong Zheng; Wei Xu; Zhifeng Li; Lingyan Ping; Xiaohua He; Liling Zhang; Caixia Li; Ying Xie; Feili Chen; Xiuhua Sun; Liping Su; Huilai Zhang; Liyuan Fan; Zhijuan Lin; Haiyan Yang; Weili Zhao; Lugui Qiu; Zhiming Li; Yuqin Song; Bing Xu

doi:10.1186/s40364-023-00462-z

Differences in clinical characteristics and outcomes between patients with grade 3a and grades 1-2 follicular lymphoma: a real-world multicenter study

Biomark Res. 2023 Feb 6;11(1):16. doi: 10.1186/s40364-023-00462-z.

Authors

Jie Zha^#^{1

2}, Qinwei Chen^#^{1

2}, Jingjing Ye^#³, Haifeng Yu^{4

5}, Shuhua Yi⁶, Zhong Zheng⁷, Wei Xu⁸, Zhifeng Li^{1

2}, Lingyan Ping⁹, Xiaohua He^{10

11

12}, Liling Zhang¹³, Caixia Li¹⁴, Ying Xie¹⁵, Feili Chen¹⁶, Xiuhua Sun¹⁷, Liping Su¹⁸, Huilai Zhang¹⁹, Liyuan Fan^{1

2}, Zhijuan Lin^{1

2}, Haiyan Yang^{4

5}, Weili Zhao⁷, Lugui Qiu⁴, Zhiming Li^{20

21

22}, Yuqin Song²³, Bing Xu^{24

25}

Affiliations

¹ Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, 361003, P.R, China.
² Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China.
³ Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
⁴ Department of Lymphoma, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.
⁵ Department of Lymphoma, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China.
⁶ State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Blood Diseases Hospital & Institute of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
⁷ Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁸ Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
⁹ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
¹⁰ Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
¹¹ State Key Laboratory of Oncology in South China, Guangzhou, China.
¹² Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
¹³ Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁴ National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
¹⁵ 15Shengli Clinical Medical College of Fujian Medical University, Department of Hematology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.
¹⁶ Lymphoma Division, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
¹⁷ Second Hospital of Dalian Medical University, Dalian, China.
¹⁸ Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China.
¹⁹ Department of Lymphoma, Tianjin Medical University Cancer Hospital, Tianjin, China.
²⁰ Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China. lizhm@sysucc.org.cn.
²¹ State Key Laboratory of Oncology in South China, Guangzhou, China. lizhm@sysucc.org.cn.
²² Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. lizhm@sysucc.org.cn.
²³ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China. songyuqin622@163.com.
²⁴ Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, 361003, P.R, China. xubing@xmu.edu.cn.
²⁵ Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China. xubing@xmu.edu.cn.

^# Contributed equally.

Abstract

Background: The difference between clinical characteristics and outcomes between follicular lymphoma grade 1-2 (FL1-2) and FL3a defined pathologically remains unclear, resulting in uncertainty how to treat FL3a. However, it may be crucial for clinicians to discriminate grade 3a and grade 1-2 for predicting prognosis and thus making treatment decisions.

Methods: We compared 1403 patients with FL1-2 and 765 patients with FL3a diagnosed between January 2000 and December 2020 from fifteen centers nationwide in China to describe differences in clinical characteristics and outcomes.

Results: Compared with FL1-2 patients, FL3a subgroup had a higher percentage of elderly patients (P = 0.003), and relatively more FL3a patients presented with increased levels of LDH (P < 0.0001) and higher Ki-67 indexs greater than 30% (P < 0.001). More FL3a patients were treated with CHOP ± R (P < 0.0001), and fewer were treated with the watchful-waiting approach (P < 0.0001). The results showed a higher incidence of relapse among FL3a patients, in which more patients underwent histological transformation (HT) when compared to FL1-2 (P = 0.003). 1470 (76.2%) patients of the entire cohort received R-CHOP therapy; survival analysis revealed that FL3a patients had a worse progression-free survival (PFS) rate than FL1-2 patients. Survival of FL3a patients with respect to FLIPI showed an inferior PFS in the intermediate and high-risk groups than FL1-2 patients. FL3a patients had a much worse prognosis than FL1-2 with or without progression of disease within 24 months (POD24). FL3a patients had higher likelihood of lymphoma-related death (LRD, P < 0.05), whereas the rates for non-LRD were comparable.

Conclusion: In conclusion, this study demonstrates a marked difference in clinical features and outcomes in FL3a patients compared with FL1-2 patients. The results highlight the need for applying therapeutic approaches distinct from FL1-2 when treating FL3a patients.

Keywords: Clinical feature; Follicular lymphoma; Histological grading; Histological transformation; survival.

Abstract

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