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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


Allison Barraclough

James T England

Diego Villa

Joel Wight

Greg Hapgood

Jason Conn

Nicole Wong Doo

Eric Wenlong Li

Michael Gilbertson

Briony Shaw

Mark J Bishton

Malik Saeed

Sumita Ratnasingam

Chathuri Abeyakoon

Geoff Chong

Shin Hnin Wai

Matthew Ku

Hui-Peng Lee

Kathryn Fleming

Constantine Tam

Genevieve Douglas

Chan Y Cheah

Zi Yun Ng

Tukten Rolfe

Anthony K Mills

Nada Hamad

Helen Cashman

Mary Gleeson

Manjunath Narayana

Eliza A Hawkes


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.


Barraclough, A., England, J. T., Villa, D., Wight, J., Hapgood, G., Conn, J., …Hawkes, E. A. (2023). Outcomes in grade 3B follicular lymphoma: an international study led by the Australasian Lymphoma Alliance. Haematologica,

Journal Article Type Article
Acceptance Date Feb 8, 2023
Online Publication Date Feb 23, 2023
Publication Date Feb 23, 2023
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
Public URL
Publisher URL


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