Haematologica (Feb 2023)

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

DOI
https://doi.org/10.3324/haematol.2022.281375
Journal volume & issue
Vol. 108, no. 9

Abstract

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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.