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Blood, Vol. 93 No. 7 (April 1), 1999:
pp. 2202-2207
Follicular Large Cell Lymphoma: An Aggressive Lymphoma That Often
Presents With Favorable Prognostic Features
J. Rodriguez,
P. McLaughlin,
F.B. Hagemeister,
L. Fayad,
M.A. Rodriguez,
M. Santiago,
M. Hess,
J. Romaguera, and
F. Cabanillas
From the University of Texas M.D. Anderson Cancer Center,
Houston, TX.
It is debated whether follicular large cell lymphoma (FLCL) has a
clinical behavior that is distinct from indolent follicular lymphomas,
and whether there is a subset of patients who can be potentially cured.
We report here our experience with 100 FLCL patients treated at our
institution since 1984 with three successive programs. We evaluated the
predictive value of pretreatment clinical features, including two risk
models, the Tumor Score System and the International Prognostic Index
(IPI). With a median follow-up of 67 months, the 5-year survival is
72% and the failure-free survival (FFS) is 67%, with a possible
plateau in the FFS curve, particularly for patients with stage I-III
disease. Features associated with shorter survival included age  60,
elevated lactic dehydrogenase (LDH) or
beta-2-microglobulin ( 2M), advanced stage, and bone marrow
involvement. Stage III patients had significantly better survival than
stage IV patients (P < .05). By the IPI and Tumor Score
System, 80% of the patients were in the lower risk groups; both
systems stratified patients into prognostic groups. Patients with FLCL
have clinical features and response to treatment similar to that
reported for diffuse large cell lymphoma. Prognostic risk systems for
aggressive lymphomas are useful for FLCL. A meaningful fraction of
patients may possibly be cured when treated as aggressive lymphomas.
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