Follicular lymphoma natural history, complications and prognosis: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
*The disease is regarded as incurable (although allogenic stem cell transplantation may be curative, the mortality from the procedure is too high to be a first line option). The [[median]] survival is around 10 years, but the range is wide, from less than one year, to more than 20 years. | *The disease is regarded as incurable (although allogenic stem cell transplantation may be curative, the mortality from the procedure is too high to be a first line option). The [[median]] survival is around 10 years, but the range is wide, from less than one year, to more than 20 years. | ||
*Follicular lymphoma is graded according to the proportion of large cells (centroblasts). Studies suggest this histologic grading predicts clinical outcome, with more large cells behaving more aggressively and having a higher likelihood of transformation to diffuse large cell lymphoma. | *Follicular lymphoma is graded according to the proportion of large cells (centroblasts). Studies suggest this histologic grading predicts clinical outcome, with more large cells behaving more aggressively and having a higher likelihood of transformation to diffuse large cell lymphoma. When any area of diffuse large-B-cell lymphoma is present in a follicular lymphoma the disease should be reported as diffuse large B-cell lymphoma.<ref name="seer">National Cancer Institute. Surveillance, Epidemiology, and End Results Program 2015. http://seer.cancer.gov</ref>. | ||
*There was no difference in survival outcomes between patients with Grade 3A and 3B follicular lymphoma, whereas patients with FL3 with more than 50% diffuse component have an inferior survival similar to the survival of those with diffuse large cell lymphoma. | *There was no difference in survival outcomes between patients with Grade 3A and 3B follicular lymphoma, whereas patients with FL3 with more than 50% diffuse component have an inferior survival similar to the survival of those with diffuse large cell lymphoma. | ||
*FL3B with cytogenetic abnormalities of BCL6 (at 3q27) are thought to be genetically more akin to germinal center type diffuse large B-cell lymphoma than FL1-3A, and is associated with a more aggressive clinical course. | *FL3B with cytogenetic abnormalities of BCL6 (at 3q27) are thought to be genetically more akin to germinal center type diffuse large B-cell lymphoma than FL1-3A, and is associated with a more aggressive clinical course. | ||
Revision as of 18:27, 25 August 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Prognosis is generally poor. The median survival is around 10 years.
Prognosis
- The disease is regarded as incurable (although allogenic stem cell transplantation may be curative, the mortality from the procedure is too high to be a first line option). The median survival is around 10 years, but the range is wide, from less than one year, to more than 20 years.
- Follicular lymphoma is graded according to the proportion of large cells (centroblasts). Studies suggest this histologic grading predicts clinical outcome, with more large cells behaving more aggressively and having a higher likelihood of transformation to diffuse large cell lymphoma. When any area of diffuse large-B-cell lymphoma is present in a follicular lymphoma the disease should be reported as diffuse large B-cell lymphoma.[1].
- There was no difference in survival outcomes between patients with Grade 3A and 3B follicular lymphoma, whereas patients with FL3 with more than 50% diffuse component have an inferior survival similar to the survival of those with diffuse large cell lymphoma.
- FL3B with cytogenetic abnormalities of BCL6 (at 3q27) are thought to be genetically more akin to germinal center type diffuse large B-cell lymphoma than FL1-3A, and is associated with a more aggressive clinical course.
- Patients with FL3B with BCL2 translocation appear to have a clinical course similar to patients with FL1-3A. Since FL3B is rare, the clinical behavior of FL3 in most studies is based mainly on FL3A cases.
1. The Follicular Lymphoma International Prognostic Index (FLIPI) includes[2]
- Age
- Ann Arbor stage
- Number of nodal sites involved
- Hemoglobin levels
- Serum LDH levels
2. The Follicular Lymphoma International Prognostic Index (FLIPI-2) includes
- Age
- Hemoglobin levels
- Longest diameter of largest involved lymph node
- Beta-2 microglobulin levels
- Bone marrow involvement
Both the FLIPI-1 and FLIPI-2 predict for prognosis, but not yet useful for selecting treatment options.
3. Most recently,a simpler prognostic index includes
- baseline serum beta 2-microglobulin
- LDH levels
References
- ↑ National Cancer Institute. Surveillance, Epidemiology, and End Results Program 2015. http://seer.cancer.gov
- ↑ "Non-Hodgkin's Lymphomas (NCCN.org)" (PDF).