Outcomes in grade 3B follicular lymphoma: an international study led by the Australasian Lymphoma Alliance

Barraclough, Allison; England, James T; Villa, Diego; Wight, Joel; Hapgood, Greg; Conn, Jason; Doo, Nicole Wong; Li, Eric Wenlong; Gilbertson, Michael; Shaw, Briony; Bishton, Mark J; Saeed, Malik; Ratnasingam, Sumita; Abeyakoon, Chathuri; Chong, Geoff; Wai, Shin Hnin; Ku, Matthew; Lee, Hui-Peng; Fleming, Kathryn; Tam, Constantine; Douglas, Genevieve; Cheah, Chan Y; Ng, Zi Yun; Rolfe, Tukten; Mills, Anthony K; Hamad, Nada; Cashman, Helen; Gleeson, Mary; Narayana, Manjunath; Hawkes, Eliza A

Abstract

Grade (G) 3B follicular lymphoma (FL) is a rare FL subtype which exists on a histological continuum between ‘low-grade’ (Grade 1, 2 and 3A FL) and diffuse large B-cell lymphoma (DLBCL) appearing to share features with each. Clinical characteristics and outcomes are poorly understood due to lack of adequate representation in prospective trials and large-scale analyses. We analyzed 157 G3BFL cases from 18 international centers, and two comparator groups; G3AFL (n=302) and DLBCL (n=548). Composite histology with DLBCL or low-grade FL occurred in approximately half of G3BFL cases. With median 5 years follow-up, G3BFL overall (OS; P<0.001) and progression-free survival (PFS; P<0.001) were superior to DLBCL however G3BFL patients were younger (P<0.001) with better performance status (P<0.001), less extranodal disease (P<0.001) and more frequently normal LDH (P<0.001) at baseline. G3BFL and G3AFL OS and PFS were similar (OS: P=0.83, PFS: P=0.80). After frontline immunochemotherapy, 24% of G3BFL relapsed; DLBCL in 63% and low-grade FL in 19%. 8% of relapses occurred beyond 5 years. In this G3BFL cohort, the R-IPI successfully delineated risk groups, but FLIPI did not. We conclude that immunochemotherapy-treated G3BFL has similar survival outcomes to G3AFL, yet a favourable baseline profile and distinctly superior prognosis compared to DLBCL.

Citation

Barraclough, A., England, J. T., Villa, D., Wight, J., Hapgood, G., Conn, J., Doo, N. W., Li, E. W., Gilbertson, M., Shaw, B., Bishton, M. J., Saeed, M., Ratnasingam, S., Abeyakoon, C., Chong, G., Wai, S. H., Ku, M., Lee, H.-P., Fleming, K., Tam, C., …Hawkes, E. A. (2023). Outcomes in grade 3B follicular lymphoma: an international study led by the Australasian Lymphoma Alliance. Haematologica, 108(9), https://doi.org/10.3324/haematol.2022.281375

• Journal Article Type: Article
• Acceptance Date: Feb 8, 2023
• Online Publication Date: Feb 23, 2023
• Publication Date: 2023-09
• Deposit Date: Feb 9, 2023
• Publicly Available Date: Feb 9, 2023
• Journal: Haematologica
• Print ISSN: 0390-6078
• Electronic ISSN: 1592-8721
• Publisher: Ferrata Storti Foundation
• Peer Reviewed: Peer Reviewed
• Volume: 108
• Issue: 9
• DOI: https://doi.org/10.3324/haematol.2022.281375
• Public URL: https://nottingham-repository.worktribe.com/output/17081816
• Publisher URL: https://haematologica.org/article/view/haematol.2022.281375