Outcomes in grade 3B follicular lymphoma: an international study led by the Australasian Lymphoma Alliance
Allison Barraclough,
James T. England,
Diego Villa,
Joel Wight,
Greg Hapgood,
Jason Conn,
Nicole Wong Doo,
Eric Wenlong Li,
Michael Gilbertson,
Briony Shaw,
Mark J. Bishton,
Malik Saeed,
Sumita Ratnasingam,
Chathuri Abeyakoon,
Geoff Chong,
Shin Hnin Wai,
Matthew Ku,
Hui-Peng Lee,
Kathryn Fleming,
Constantine Tam,
Genevieve Douglas,
Chan Y. Cheah,
Zi Yun Ng,
Tukten Rolfe,
Anthony K Mills,
Nada Hamad,
Helen Cashman,
Mary Gleeson,
Manjunath Narayana,
Eliza A. Hawkes
Affiliations
Allison Barraclough
Fiona Stanley Hospital, Department of Haematology, Perth, Australia; University of Melbourne, Melbourne
James T. England
University of British Columbia and BC Cancer Centre for Lymphoid Cancer, Vancouver, Canada; Princess Margaret Cancer Centre, Toronto
Diego Villa
University of British Columbia and BC Cancer Centre for Lymphoid Cancer, Vancouver
Joel Wight
University of Melbourne, Melbourne, Australia; Townsville University Hospital, Department of Haematology, Townsville
Greg Hapgood
Princess Alexandra Hospital, Department of Haematology, Brisbane
Jason Conn
Princess Alexandra Hospital, Department of Haematology, Brisbane
Nicole Wong Doo
Concord Clinical School, University of Sydney, Sydney
Eric Wenlong Li
Concord Clinical School, University of Sydney, Sydney
Michael Gilbertson
Monash Health, Department of Haematology, Melbourne, Australia; School of Clinical Sciences, Monash University, Melbourne
Briony Shaw
Monash Health, Department of Haematology, Melbourne
Mark J. Bishton
Nottingham City Hospital, Department of Haematology, Nottingham
Malik Saeed
Nottingham City Hospital, Department of Haematology, Nottingham
Sumita Ratnasingam
University Hospital Geelong, Department of Haematology, Geelong
Chathuri Abeyakoon
University Hospital Geelong, Department of Haematology, Geelong
Geoff Chong
University of Melbourne, Melbourne, Australia; Ballarat Regional Integrated Cancer Centre, Ballarat Health Services, Melbourne, Australia; Department of Medical Oncology and Haematology, Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne
Shin Hnin Wai
Department of Medical Oncology and Haematology, Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne, Australia; The Northern Hospital, Department of Haematology, Melbourne
Matthew Ku
University of Melbourne, Melbourne, Australia; St Vincent’s Hospital Melbourne, Department of Haematology, Melbourne
Hui-Peng Lee
Flinders Medical Centre, Department of Haematology, Adelaide
Kathryn Fleming
Flinders Medical Centre, Department of Haematology, Adelaide
Constantine Tam
University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Department of Haematology, Melbourne
Genevieve Douglas
Department of Medical Oncology and Haematology, Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne
Chan Y. Cheah
Sir Charles Gairdner Hospital, Department of Haematology, Perth, Australia; University of Western Australia, Medical School, Perth
Zi Yun Ng
Sir Charles Gairdner Hospital, Department of Haematology, Perth
Tukten Rolfe
Greenslopes Private Hospital, Brisbane
Anthony K Mills
Greenslopes Private Hospital, Brisbane
Nada Hamad
St Vincent’s Hospital Sydney, Department of Haematology, Sydney, Australia; School of Clinical Medicine, University of New South Wales, Sydney, Australia; School of Medicine, University of Notre Dame, Sydney
Helen Cashman
St Vincent’s Hospital Sydney, Department of Haematology, Sydney
Mary Gleeson
Guy’s and St. Thomas’ NHS Foundation Trust, Department of Haematology, London
Manjunath Narayana
Sunshine Coast University Hospital, Department of Haematology, Birtinya
Eliza A. Hawkes
Department of Medical Oncology and Haematology, Olivia Newton-John Cancer Research and Wellness Centre, Austin Health, Melbourne, Australia; Transfusion Research Unit, Monash University, Melbourne
Grade (G) 3B follicular lymphoma (FL) is a rare FL subtype which exists on a histological continuum between ‘lowgrade’ (Grade 1, 2 and 3A FL) and diffuse large B-cell lymphoma (DLBCL) appearing to share features with each. Clinical characteristics and outcomes are poorly understood due to lack of adequate representation in prospective trials and large-scale analyses. We analyzed 157 G3BFL cases from 18 international centers, and two comparator groups; G3AFL (n=302) and DLBCL (n=548). Composite histology with DLBCL or low-grade FL occurred in approximately half of the G3BFL cases. With a median of 5 years follow-up, the overall survival and progression-free survival of G3BFL patients was better than that of DLBCL patients (P<0.001 and P<0.001, respectively); however, G3BFL patients were younger (P<0.001) with better performance status (P<0.001), less extranodal disease (P<0.001) and more frequently had normal lactate dehydrogenase (P<0.001) at baseline. The overall and progression-free survival of patients with G3BFL and G3AFL were similar (P=0.83 and P=0.80, respectively). After frontline immunochemotherapy, 24% of G3BFL relapsed; relapse rates were 63% in the DLBCL cohort and 19% in the low-grade FL cohort. Eight percent of relapses occurred beyond 5 years. In this G3BFL cohort, the revised International Prognostic Index successfully delineated risk groups, but the Follicular Lymphoma International Prognostic Index did not. We conclude that patients with immunochemotherapy-treated G3BFL have similar survival outcomes to those with G3AFL, yet a favorable baseline profile and distinctly superior prognosis compared to patients with DLBCL.
