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Coexistence of diffuse large B-cell lymphoma, follicular lymphoma does not worsen prognosis
Patients with diffuse large B-cell lymphoma and follicular lymphoma at diagnosis did not have worse prognoses than patients with de novo DLBCL, according to study results.
DLBCL is often identified at diagnosis of follicular lymphoma. The observation of both follicular lymphoma and DLBCL components in the same biopsy is considered early transformation. Clinical information about these patients is scarce.
Researchers evaluated all consecutive patients diagnosed with follicular lymphoma/DLBCL (n=40; median age, 65 years), pure follicular lymphoma (n=328) or de novo DLBCL (n=510) at a single institution between 2002 and 2015.
The researchers sought to analyze initial features and outcomes of patients with follicular lymphoma/DLBCL in the rituximab (Rituxan; Genentech, Biogen) era.
Cell-of-original classification data from 29 patients with follicular lymphoma/DLBCL showed the cell of origin was germinal center B-cell like DLBCL in 86%; activated B-cell like DLBCL in 10% and unclassifiable in 4%. In addition, 10% of cases presented with NOTCH1 and NOTCH2 mutations, compared with 2% of pure follicular lymphoma cases and 8% of de novo DLBCL cases.
Analyzation of initial characteristics placed patients with follicular lymphoma/DLBCL closer to pure follicular lymphoma as related to primary nodal origin, good performance status and advanced stage. Other features — including B-symptoms, bone marrow infiltration, hemoglobin and serum lactate dehydrogenase — appeared to be intermediate between follicular lymphoma and DLBCL.
Patients with follicular lymphoma/DLBCL received treatment for DLBCL without further intensification. Sixty-five percent of patients with follicular lymphoma/DLBCL achieved complete response and 20% were primary refractory; the refractory rate appeared similar to patients with de novo DLBCL (23%), but worse than for patients with pure follicular lymphoma (5%; P = .002).
When analyzing patients with follicular lymphoma/DLBCL, those with germinal center B-cell like disease had better 5-year OS (70% vs. 40%) and 5-year PFS (60% vs. 33%) than patients with activated B-cell like disease.
The presence of DLBCL component appeared associated with shorter PFS but similar OS.
After a median follow-up of 5.7 years for surviving patients, rates of 5-year PFS were 65% for follicular lymphoma, 55% for follicular lymphoma/DLBCL and 50% for de novo DLBLC.
The 5-year OS rate was 85% among follicular lymphoma cases compared with 73% among follicular lymphoma/DLBCL cases and 63% for DLBCL cases.
Compared with patients with follicular lymphoma, Cox models showed HRs of 2.97 (P < .001) for DLBCL and 1.69 (P = .013) for follicular lymphoma/DLBCL.
“The main conclusion of this manuscript is that, when treated as aggressive lymphomas, patients with follicular lymphoma/DLBCL have an outcome definitely not worse than that of de novo DLBCL,” the researchers wrote. “Few studies, mainly in the prerituximab era, have previously addressed this issue.” – by Melinda Stevens
Disclosures: The authors report no relevant financial disclosures.