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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

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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.

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 (Haematologica)
Peer Reviewed Peer Reviewed
Volume 108
Issue 9
Public URL
Publisher URL