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Prepublished online as a Blood First Edition Paper on November 7, 2002; DOI 10.1182/blood-2002-07-2298.
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Blood, 15 March 2003, Vol. 101, No. 6, pp. 2363-2367
NEOPLASIA
A significant diffuse component predicts for inferior survival in
grade 3 follicular lymphoma, but cytologic subtypes do not predict
survival
Christine P. Hans,
Dennis
D. Weisenburger,
Julie M. Vose,
Lynette M. Hock,
James C. Lynch,
Patricia Aoun,
Timothy C. Greiner,
Wing C. Chan,
Robert G. Bociek,
Philip J. Bierman, and
James O. Armitage
From the Departments of Pathology and Microbiology,
Internal Medicine, and Preventive and Societal Medicine, University of
Nebraska Medical Center, Omaha, NE.
Grade 3 follicular lymphoma (FL3) is thought to have an aggressive
clinical course. On the basis of possible biologic differences, the new
World Health Organization (WHO) classification of lymphoma suggests further subdivision of FL3 into grades 3a and 3b and states
that the percentage of involvement by diffuse large B-cell lymphoma
(DLBCL) should also be reported. However, the clinical implications of
these features are unclear. Therefore, we studied 190 newly diagnosed
patients with lymph node-based FL3 who received anthracycline-containing combination chemotherapy. The follicular component was subclassified as grade 3a (FL3a) or grade 3b (FL3b) according to the WHO criteria, or as follicular large cleaved cell type
(FLC). The percentage of a diffuse component, if present, was also
recorded. Of the 190 cases, there were 107 FL3a (56%), 53 FL3b (28%),
and 30 FLC (16%) cases. Diffuse areas were seen in 72 cases (31 FL3a,
28 FL3b, and 13 FLC). There were no significant differences in the
clinical characteristics, overall survival, or event-free survival
between patients with grades FL3a, FL3b, or FLC. However, those cases
with a predominant diffuse component (> 50% diffuse) had a
significantly worse overall survival (P = .0037) and
event-free survival (P = .012). Therefore, we conclude that the subdivision of FL3 into cytologic subtypes does not appear to
be important clinically. However, patients with FL3 having a diffuse
component of more than 50% have an inferior survival that is similar
to the survival of those with DLBCL.

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