THE IMPACT OF HISTOLOGIC GRADING ON THE OUTCOME OF FOLLICULAR LYMPHOMA: IS GRADE 3 FOR BETTER OR FOR WORSE?
(Abstract release date: 05/19/16)
EHA Library. Angelopoulou M. 06/09/16; 132706; E1157
Dr. Maria Angelopoulou
Contributions
Contributions
Abstract
Abstract: E1157
Type: Eposter Presentation
Background
Follicular lymphoma (FL) is an indolent lymphoma with an excellent prognosis. With the incorporation of chemoimmunotherapy, more than 70% of the patients survive at 10 years. The clinical significance of FL histologic grading according to the WHO Classification into grades 1/2 and grades 3A and 3B is still a matter of debate.
Aims
To study the clinical and laboratory characteristics of grade 3A and 3B FL compared to grades 1 and 2 and to explore whether higher grades are associated with a worse outcome.
Methods
We retrospectively studied all patients with FL diagnosed and treated in a single University Hematology Unit between 2001 and 2015.
Results
Among 200 consecutive patients with FL with a median follow-up of 76 months (0.1-186), 53 patients with grade 3 FL were identified (47 with grade 3A and 6 with grade 3B). Patients’ characteristics are shown in the table. The comparison between grade 3 and grades 1 and 2 patients revealed the following significant differences: Grade 3 cases had more frequently Ki-67>30% (p<0.0001), CD10 negativity (p=0.009), high LDH levels (p=0.009) and lymphocytopenia <0.8/μL (p=0.05). FLIPI score and bulky disease did not differ significantly. There was a trend that did not reach statistical significance for male gender, localized stage and absence of bone marrow involvement to be more frequent in grade 3 compared to grades 1/2. Treatment also differed significantly between the two groups (p<0.0001): 60% of grade 3 patients were treated with Rituximab (R)-CHOP, while 52% of grade 1/2 patients were treated with R-alkylators (chlorambucil or CVP). The outcome of grade 3 patients was not inferior: 10-year PFS was 64% vs 55.6% and 10-year OS was 83.7% vs 84.4% for grade 3 and grade 1/2 patients, respectively. Moreover, a plateau in the survival curves of grade 3 patients was observed in contrast to a constantly relapsing course of grades 1 and 2 cases. Among the 53 patients with grade 3, prognostic factor analysis revealed that Ki-67, age, gender, stage, LDH, bulk and FLIPI score did not have any significance for outcome, while there was a trend for superior PFS for R-CHOP treated patients (p=0.08) with a 10-year PFS of 67.3% vs 31.3% for patients treated with other modalities. However, overall survival did not differ between aggressive and low intensity treatment strategies. Of note, stage and FLIPI were well balanced between the two groups. Table: Patients’ Characteristics (N=53)
Conclusion
Grade 3 FL patients show more frequently high Ki-67 expression, CD10 negativity, elevated LDH and lymphocytopenia compared with lower grade FL patients. However, the long-term outcome of grade 3 FL is equally favorable with plateaus in the survival curves.
Session topic: E-poster
Keyword(s): Follicular lymphoma, Indolent non-Hodgkin's lymphoma, Prognostic factor
Type: Eposter Presentation
Background
Follicular lymphoma (FL) is an indolent lymphoma with an excellent prognosis. With the incorporation of chemoimmunotherapy, more than 70% of the patients survive at 10 years. The clinical significance of FL histologic grading according to the WHO Classification into grades 1/2 and grades 3A and 3B is still a matter of debate.
Aims
To study the clinical and laboratory characteristics of grade 3A and 3B FL compared to grades 1 and 2 and to explore whether higher grades are associated with a worse outcome.
Methods
We retrospectively studied all patients with FL diagnosed and treated in a single University Hematology Unit between 2001 and 2015.
Results
Among 200 consecutive patients with FL with a median follow-up of 76 months (0.1-186), 53 patients with grade 3 FL were identified (47 with grade 3A and 6 with grade 3B). Patients’ characteristics are shown in the table. The comparison between grade 3 and grades 1 and 2 patients revealed the following significant differences: Grade 3 cases had more frequently Ki-67>30% (p<0.0001), CD10 negativity (p=0.009), high LDH levels (p=0.009) and lymphocytopenia <0.8/μL (p=0.05). FLIPI score and bulky disease did not differ significantly. There was a trend that did not reach statistical significance for male gender, localized stage and absence of bone marrow involvement to be more frequent in grade 3 compared to grades 1/2. Treatment also differed significantly between the two groups (p<0.0001): 60% of grade 3 patients were treated with Rituximab (R)-CHOP, while 52% of grade 1/2 patients were treated with R-alkylators (chlorambucil or CVP). The outcome of grade 3 patients was not inferior: 10-year PFS was 64% vs 55.6% and 10-year OS was 83.7% vs 84.4% for grade 3 and grade 1/2 patients, respectively. Moreover, a plateau in the survival curves of grade 3 patients was observed in contrast to a constantly relapsing course of grades 1 and 2 cases. Among the 53 patients with grade 3, prognostic factor analysis revealed that Ki-67, age, gender, stage, LDH, bulk and FLIPI score did not have any significance for outcome, while there was a trend for superior PFS for R-CHOP treated patients (p=0.08) with a 10-year PFS of 67.3% vs 31.3% for patients treated with other modalities. However, overall survival did not differ between aggressive and low intensity treatment strategies. Of note, stage and FLIPI were well balanced between the two groups. Table: Patients’ Characteristics (N=53)
| Characteristic | N (%) |
| Median age in years (range) | 59 (25-83) |
| Male gender | 27 (51) |
Stage
| 25 (47)28 (53) |
FLIPI
| 26 (49)13 (24)14 (26) |
| Median hemoglobin in g/dL (range) | 13.5 (7.8-15.8) |
| Median lymphocyte counts –x109/L (range) | 1.76 (0.64-45.8) |
| Median platelet counts - x109/L (range) | 229 (103-556) |
| Elevated LDH | 11 (21) |
| Bone marrow involvement | 17 (32) |
| Bulky disease | 9 (17) |
Treatment
| 1 (2)5 (10)1 (2)2 (4)1 (2)1 (2)1 (2)9 (17)31 (60) |
Conclusion
Grade 3 FL patients show more frequently high Ki-67 expression, CD10 negativity, elevated LDH and lymphocytopenia compared with lower grade FL patients. However, the long-term outcome of grade 3 FL is equally favorable with plateaus in the survival curves.
Session topic: E-poster
Keyword(s): Follicular lymphoma, Indolent non-Hodgkin's lymphoma, Prognostic factor
Abstract: E1157
Type: Eposter Presentation
Background
Follicular lymphoma (FL) is an indolent lymphoma with an excellent prognosis. With the incorporation of chemoimmunotherapy, more than 70% of the patients survive at 10 years. The clinical significance of FL histologic grading according to the WHO Classification into grades 1/2 and grades 3A and 3B is still a matter of debate.
Aims
To study the clinical and laboratory characteristics of grade 3A and 3B FL compared to grades 1 and 2 and to explore whether higher grades are associated with a worse outcome.
Methods
We retrospectively studied all patients with FL diagnosed and treated in a single University Hematology Unit between 2001 and 2015.
Results
Among 200 consecutive patients with FL with a median follow-up of 76 months (0.1-186), 53 patients with grade 3 FL were identified (47 with grade 3A and 6 with grade 3B). Patients’ characteristics are shown in the table. The comparison between grade 3 and grades 1 and 2 patients revealed the following significant differences: Grade 3 cases had more frequently Ki-67>30% (p<0.0001), CD10 negativity (p=0.009), high LDH levels (p=0.009) and lymphocytopenia <0.8/μL (p=0.05). FLIPI score and bulky disease did not differ significantly. There was a trend that did not reach statistical significance for male gender, localized stage and absence of bone marrow involvement to be more frequent in grade 3 compared to grades 1/2. Treatment also differed significantly between the two groups (p<0.0001): 60% of grade 3 patients were treated with Rituximab (R)-CHOP, while 52% of grade 1/2 patients were treated with R-alkylators (chlorambucil or CVP). The outcome of grade 3 patients was not inferior: 10-year PFS was 64% vs 55.6% and 10-year OS was 83.7% vs 84.4% for grade 3 and grade 1/2 patients, respectively. Moreover, a plateau in the survival curves of grade 3 patients was observed in contrast to a constantly relapsing course of grades 1 and 2 cases. Among the 53 patients with grade 3, prognostic factor analysis revealed that Ki-67, age, gender, stage, LDH, bulk and FLIPI score did not have any significance for outcome, while there was a trend for superior PFS for R-CHOP treated patients (p=0.08) with a 10-year PFS of 67.3% vs 31.3% for patients treated with other modalities. However, overall survival did not differ between aggressive and low intensity treatment strategies. Of note, stage and FLIPI were well balanced between the two groups. Table: Patients’ Characteristics (N=53)
Conclusion
Grade 3 FL patients show more frequently high Ki-67 expression, CD10 negativity, elevated LDH and lymphocytopenia compared with lower grade FL patients. However, the long-term outcome of grade 3 FL is equally favorable with plateaus in the survival curves.
Session topic: E-poster
Keyword(s): Follicular lymphoma, Indolent non-Hodgkin's lymphoma, Prognostic factor
Type: Eposter Presentation
Background
Follicular lymphoma (FL) is an indolent lymphoma with an excellent prognosis. With the incorporation of chemoimmunotherapy, more than 70% of the patients survive at 10 years. The clinical significance of FL histologic grading according to the WHO Classification into grades 1/2 and grades 3A and 3B is still a matter of debate.
Aims
To study the clinical and laboratory characteristics of grade 3A and 3B FL compared to grades 1 and 2 and to explore whether higher grades are associated with a worse outcome.
Methods
We retrospectively studied all patients with FL diagnosed and treated in a single University Hematology Unit between 2001 and 2015.
Results
Among 200 consecutive patients with FL with a median follow-up of 76 months (0.1-186), 53 patients with grade 3 FL were identified (47 with grade 3A and 6 with grade 3B). Patients’ characteristics are shown in the table. The comparison between grade 3 and grades 1 and 2 patients revealed the following significant differences: Grade 3 cases had more frequently Ki-67>30% (p<0.0001), CD10 negativity (p=0.009), high LDH levels (p=0.009) and lymphocytopenia <0.8/μL (p=0.05). FLIPI score and bulky disease did not differ significantly. There was a trend that did not reach statistical significance for male gender, localized stage and absence of bone marrow involvement to be more frequent in grade 3 compared to grades 1/2. Treatment also differed significantly between the two groups (p<0.0001): 60% of grade 3 patients were treated with Rituximab (R)-CHOP, while 52% of grade 1/2 patients were treated with R-alkylators (chlorambucil or CVP). The outcome of grade 3 patients was not inferior: 10-year PFS was 64% vs 55.6% and 10-year OS was 83.7% vs 84.4% for grade 3 and grade 1/2 patients, respectively. Moreover, a plateau in the survival curves of grade 3 patients was observed in contrast to a constantly relapsing course of grades 1 and 2 cases. Among the 53 patients with grade 3, prognostic factor analysis revealed that Ki-67, age, gender, stage, LDH, bulk and FLIPI score did not have any significance for outcome, while there was a trend for superior PFS for R-CHOP treated patients (p=0.08) with a 10-year PFS of 67.3% vs 31.3% for patients treated with other modalities. However, overall survival did not differ between aggressive and low intensity treatment strategies. Of note, stage and FLIPI were well balanced between the two groups. Table: Patients’ Characteristics (N=53)
| Characteristic | N (%) |
| Median age in years (range) | 59 (25-83) |
| Male gender | 27 (51) |
Stage
| 25 (47)28 (53) |
FLIPI
| 26 (49)13 (24)14 (26) |
| Median hemoglobin in g/dL (range) | 13.5 (7.8-15.8) |
| Median lymphocyte counts –x109/L (range) | 1.76 (0.64-45.8) |
| Median platelet counts - x109/L (range) | 229 (103-556) |
| Elevated LDH | 11 (21) |
| Bone marrow involvement | 17 (32) |
| Bulky disease | 9 (17) |
Treatment
| 1 (2)5 (10)1 (2)2 (4)1 (2)1 (2)1 (2)9 (17)31 (60) |
Conclusion
Grade 3 FL patients show more frequently high Ki-67 expression, CD10 negativity, elevated LDH and lymphocytopenia compared with lower grade FL patients. However, the long-term outcome of grade 3 FL is equally favorable with plateaus in the survival curves.
Session topic: E-poster
Keyword(s): Follicular lymphoma, Indolent non-Hodgkin's lymphoma, Prognostic factor
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