Clinicopathological characteristics of patients with follicular lymphoma

Authors

  • Elías Antonio Gracia Medina Instituto Nacional de Oncología y Radiobiología
  • Brenda Benítez Caballero
  • Daniel Ricardo Martínez Avila
  • Caridad López Galiano
  • Tamara Gonzalez Madruga
  • Julio Jiménez Galaimena
  • Dagmar Alfonso Estevez
  • Danoy Sanchez Pérez
  • Danay Corrales Otero
  • Encamación Vásquez Olazabal

Abstract

Introduction: Follicular lymphoma represents one third of all non-Hodgkin lymphomas. Its mean overall survival rate is above 10 years.

Objective: Characterize patients diagnosed with follicular lymphoma attending the Institute of Oncology and Radiobiology from 2008 to 2017.

Methods: An observational retrospective study was conducted of 87 patients diagnosed with follicular lymphoma. The variables considered were demographic characteristics of patients, disease features at diagnosis and treatment indicated. Overall survival was estimated with the Kaplan-Meier method.

Results: Mean age at diagnosis was 58 years. 21.8% of the patients presented B symptoms at debut. According to Ann Arbor staging, 33% and 24.1% were at clinical stage III and IV, respectively. In two thirds of the lymphomas, international prognostic index classification was intermediate or high, 34.5% each. Chemotherapy alone was the most common therapy mode with 77%. 31.4% of the patients received rituximab-related regimens, of which 25.4% were anthracycline-based. Overall survival was 87.0% at three years, 79.5% at five years and 60.2% at ten years.

Conclusions: The characteristics of patients were similar to those published in international studies.

Key words: follicular lymphoma; survival; FLIPI.

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Author Biography

Elías Antonio Gracia Medina, Instituto Nacional de Oncología y Radiobiología

Jefe Servicio de Oncología Médica

References

1. Jaffe, E. S., Swerdlow, S. H. & Vardiman, J. W. in World Cancer Report: Cancer Research for Cancer Prevention (eds Wild CP, Weiderpass E, Stewart BW) 482–494 (IARC, 2020). Disponible en https://www.iccp-portal.org/system/files/resources/IARC%20World%20Cancer%20Report%202020.pdf

2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6):394–424. https://doi.org/10.3322/caac.21492

3. Miranda-Filho A, Piñeros M, Znaor A, Marcos-Gragera R, Steliarova-Foucher E, Bray F. Global patterns and trends in the incidence of non-Hodgkin lymphoma. Cancer Causes Control. 2019 May;30(5):489-499. https://doi.org/10.1007/s10552-019-01155-5

4. Anuario Estadístico de Salud 2019, Dirección de Registros Médicos y Estadísticas de Salud. Ministerio de Salud Pública de Cuba. La Habana; 2020. p. 18-106 Disponible en: https://salud.msp.gob.cu/wp-content/Anuario/anuario_2019_edici%C3%B3n_2020.pdf

5. Magnoli F, Tibiletti MG, Uccella S. Unraveling Tumor Heterogeneity in an Apparently Monolithic Disease: BCL2 and Other Players in the Genetic Landscape of Nodal Follicular Lymphoma. Front Med (Lausanne). 2019 Mar 15;6:44. https://doi.org/10.3389/fmed.2019.00044

6. Mondello P, Steiner N, Willenbacher W, Cerchione C, Nappi D, Mauro E, et al. Bendamustine plus Rituximab Versus R-CHOP as First-Line Treatment for Patients with Follicular Lymphoma Grade 3A: Evidence from a Multicenter, Retrospective Study. Oncologist. 2018 Apr;23(4):454-460. https://doi.org/10.1634/theoncologist.2017-0037

7. Kosmidis P, Mankel B, Fend F, Adam P. The t(14;18) translocation is absent from endothelial and follicular dendritic cells of follicular lymphoma (FL) and shows heterogeneous presence in preserved FL mantle zones. Diagn Pathol. 2018 May 2;13(1):25. https://doi.org/10.1186/s13000-018-0703-2

8. Yazdy MS, Ujjani C. Current challenges in the management of follicular lymphoma. Int J Hematol Oncol. 2017 Jun;6(1):13-24. https://doi.org/10.2217/ijh-2017-0003

9. Choi WW, Weisenburger DD, Greiner TC, Piris MA, Banham AH, Delabie J, et al. A new immunostain algorithm classifies diffuse large B-cell lymphoma into molecular subtypes with high accuracy. Clin Cancer Res. 2009 Sep 1;15(17):5494-502. https://doi.org/10.1158/1078-0432.CCR-09-0113

10. Choi SM, Betz BL, Perry AM. Follicular Lymphoma Diagnostic Caveats and Updates. Arch Pathol Lab Med. 2018 Nov;142(11):1330-1340. https://doi.org/10.5858/arpa.2018-0217-RA

11. Sarkozy C, Maurer MJ, Link BK, Ghesquieres H, Nicolas E, Thompson CA, et al. Cause of Death in Follicular Lymphoma in the First Decade of the Rituximab Era: A Pooled Analysis of French and US Cohorts. J Clin Oncol. 2019 Jan 10;37(2):144-152. https://doi.org/10.1200/JCO.18.00400

12. Dada R. Diagnosis and management of follicular lymphoma: A comprehensive review. Eur J Haematol. 2019; 103:152–163. https://doi.org/10.1111/ejh.13271

13. Hoskin P, Popova B, Schofield O, Brammer C, Robinson M, Brunt AM, et al. 4 Gy versus 24 Gy radiotherapy for follicular and marginal zone lymphoma (FoRT): long-term follow-up of a multicentre, randomised, phase 3, non-inferiority trial. Lancet Oncol. 2021 Mar;22(3):332-340. https://doi.org/10.1016/S1470-2045(20)30686-0

14. Guadagnolo BA, Li S, Neuberg D, Ng A, Hua L, Silver B, et al. Long-term outcome and mortality trends in early-stage, Grade 1-2 follicular lymphoma treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2006 Mar 1;64(3):928-34. https://doi.org/10.1016/j.ijrobp.2005.08.010

15. Ardeshna KM, Qian W, Smith P, Braganca N, Lowry L, Patrick P, et al. Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lymphoma: an open-label randomised phase 3 trial. Lancet Oncol. 2014 Apr;15(4):424-35. https://doi.org/10.1016/S1470-2045(14)70027-0

16. Batlevi CL, Sha F, Alperovich A, Ni A, Smith K, Ying Z, et al. Follicular lymphoma in the modern era: survival, treatment outcomes, and identification of high-risk subgroups. Blood Cancer Journal (2020) 10:74.Disponible en: https://doi.org/10.1038/s41408-020-00340-z

17. Bachy E, Maurer MJ, Habermann TM, Gelas-Dore B, Maucort-Boulch D, Estell JA, et al. A simplified scoring system in de novo follicular lymphoma treated initially with immunochemotherapy. Blood. 2018 Jul 5;132(1):49-58. https://doi.org/10.1182/blood-2017-11-816405

18. Alig S, Jurinovic V, Pastore A, Haebe S, Schmidt C, Zoellner AK, et al. Impact of age on clinical risk scores in follicular lymphoma. Blood Adv. 2019 Apr 9;3(7):1033-1038. https://doi.org/10.1182/bloodadvances.2019032136.

19. List of classifications, agents classified by the IARC monographs. In: IARC monographs on the evaluation of risk to humans, vol. 1-124. IARC; 2019. Disponible en: https://monographs.iarc.fr/agents-classifiedby-the-iarc/

20. Cerhan JR. Epidemiology off Follicular Lymphoma. Hematol Oncol Clin N Am 34 (2020) 631–646. https://doi.org/10.1016/j.hoc.2020.02.001

21. Dal Maso L, Franceschi S. Hepatitis C virus and risk of lymphoma and other lymphoid neoplasms: a meta-analysis of epidemiologic studies. Cancer Epidemiol Biomarkers Prev 2006;15:2078–85.

22. Anderson LA, Pfeiffer R, Warren JL, Landgren O, Gadalla S, Berndt SI, et al. Hematopoietic malignancies associated with viral and alcoholic hepatitis. Cancer Epidemiol Biomarkers Prev. 2008 Nov;17(11): 3069–75. http://doi:10.1158/1055-9965.

23. Krishnan B, Morgan GJ. Non-Hodgkin lymphoma secondary to cancer chemotherapy. Cancer Epidemiol Biomarkers Prev 2007;16:377–80.

24. Kim CJ, Freedman DM, Curtis RE, de Gonzalez AB, Morton LM. Risk of non-Hodgkin lymphoma after radiotherapy for solid cancers. Leuk Lymphoma 2013;54:1691–7. http://doi:10.3109/10428194.2012.753543

25. Cho SH, Suh C, Do YR, Lee JJ, Yun HJ, Oh SY, et al. Clinical Features and Survival of Patients With Follicular Lymphoma in Korea. Clin Lymphoma Myeloma Leuk. 2016 Apr;16(4):197-202. https://doi.org/10.1016/j.clml.2015.12.012

26. López-Guillermo A, Montserrar E, Bosch F, Terol MJ, Campo E, Rozman C. Applicability of the International Index for aggressive lymphomas to patients with low-grade lymphoma. J Clin Oncol. 1994; 12: 1343-8. Disponible en: https://doi.org/10.1200/JCO.1994.12.7.1343

27. Solal-Céligny P, Roy P, Colombat P, White J, Armitage JO, Arranz-Saez R, et al. Follicular Lymphoma International Prognostic Index. Blood 2004; 104: 1258-65. https://doi.org/10.1182/blood-2003-12-4434

28. Maucort-Boulch JA, Estell E, Réda Bouabdallah EG, Andrew E, Matthew M, Habermann T, et al. A simplified scoring system in de novo follicular lymphoma treated initially with immunochemotherapy. Prepublished online April 17, 2018. https://doi.org/10.1182/blood-2017-11-816405

29. Asociación Castellana-Leonesa de Hematología y Hemoterapia. GUÍA DE LINFOMAS. Madrid, España: Doing Soluciones Gráficas S.A; 2017. ISBN 978-84-940139-6-6. Disponible en https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiDkaGoo_7xAhUGRTABHY0ABp8QFjABegQIBhAD&url=https%3A%2F%2Fwww.agapea.com%2FMaria-Jesus-et-al-Penarrubia%2FGUIA-DE-LINFOMAS-2017-9788494013966-i.htm&usg=AOvVaw1RM_tGjP64J6INTmRux3FU

30. Albarmawi H, Nagarajan M, Onukwugha E, Bipin Gandhi A, Keating KN, Appukkuttan S. Follicular lymphoma treatment patterns between 2000 and 2014: a SEER-Medicare analysis of elderly patients. Future Oncol. (2020) 16(8), 353–365 https://doi.org/10.2217/fon-2019-0660

31. Sarkozy C, Maurer MJ, Link BK, Ghesquieres H, Nicolas E, Thompson CA, et al. Cause of Death in Follicular Lymphoma in the First Decade of the Rituximab Era: A Pooled Analysis of French and US Cohorts. J Clin Oncol. 2019 Jan 10;37(2):144-152. https://doi.org/10.1200/JCO.18.00400.

32. Sant M, Minicozzi P, Mounier M, Anderson LA, Brenner H, Holleczek B, et al. Survival for haematological malignancies in Europe between 1997 and 2008 by region and age: results of EUROCARE-5, a population-based study. Lancet Oncol. 2014 Aug;15(9):931-42. https://doi.org/10.1016/S1470-2045(14)70282-7

Published

2021-10-05

How to Cite

1.
Gracia Medina EA, Benítez Caballero B, Martínez Avila DR, López Galiano C, Gonzalez Madruga T, Jiménez Galaimena J, et al. Clinicopathological characteristics of patients with follicular lymphoma. Rev Cub Oncol [Internet]. 2021 Oct. 5 [cited 2025 Jul. 1];19(3). Available from: https://revoncologia.sld.cu/index.php/onc/article/view/147

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