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:10.3324/haematol.2022.281375

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 TamGenevieve Douglas, Chan Y. Cheah, Zi Yun Ng, Tukten Rolfe, Anthony K. Mills, Nada Hamad, Helen Cashman, Mary Gleeson, Manjunath Narayana, Eliza A. Hawkes

Internal Medicine

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Grade (G) 3B follicular lymphoma (FL) is a rare FL subtype which exists on a histological continuum between ‘low-grade’ (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.

Original language	English
Pages (from-to)	2444-2453
Number of pages	10
Journal	Haematologica
Volume	108
Issue number	9
DOIs	https://doi.org/10.3324/haematol.2022.281375
Publication status	Published - Sept 2023

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Barraclough, A., England, J. T., Villa, D., Wight, J., Hapgood, G., Conn, J., Doo, N. W., Li, E. W., Gilbertson, M., Shaw, B., Bishton, M. J., Saeed, M., Ratnasingam, S., Abeyakoon, C., Chong, G., Wai, S. H., Ku, M., Lee, H. P., Fleming, K., ... Hawkes, E. A. (2023). Outcomes in grade 3B follicular lymphoma: an international study led by the Australasian Lymphoma Alliance. Haematologica, 108(9), 2444-2453. https://doi.org/10.3324/haematol.2022.281375

@article{c2ff3d0f2d9740c9921013d8f6b2847e,

title = "Outcomes in grade 3B follicular lymphoma: an international study led by the Australasian Lymphoma Alliance",

abstract = "Grade (G) 3B follicular lymphoma (FL) is a rare FL subtype which exists on a histological continuum between {\textquoteleft}low-grade{\textquoteright} (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.",

author = "Allison Barraclough and England, {James T.} and Diego Villa and Joel Wight and Greg Hapgood and Jason Conn and Doo, {Nicole Wong} and Li, {Eric Wenlong} and Michael Gilbertson and Briony Shaw and Bishton, {Mark J.} and Malik Saeed and Sumita Ratnasingam and Chathuri Abeyakoon and Geoff Chong and Wai, {Shin Hnin} and Matthew Ku and Lee, {Hui Peng} and Kathryn Fleming and Constantine Tam and Genevieve Douglas and Cheah, {Chan Y.} and Ng, {Zi Yun} and Tukten Rolfe and Mills, {Anthony K.} and Nada Hamad and Helen Cashman and Mary Gleeson and Manjunath Narayana and Hawkes, {Eliza A.}",

note = "Funding Information: This study was supported by a Royal Australasian College of Physicians Research Entry Scholarship to Allison Barraclough. Publisher Copyright: {\textcopyright} 2023 Ferrata Storti Foundation.",

year = "2023",

month = sep,

doi = "10.3324/haematol.2022.281375",

language = "English",

volume = "108",

pages = "2444--2453",

journal = "Haematologica",

issn = "0390-6078",

publisher = "Ferrata Storti Foundation",

number = "9",

}

Barraclough, A, England, JT, Villa, D, Wight, J, Hapgood, G, Conn, J, Doo, NW, Li, EW, Gilbertson, M, Shaw, B, Bishton, MJ, Saeed, M, Ratnasingam, S, Abeyakoon, C, Chong, G, Wai, SH, Ku, M, Lee, HP, Fleming, K, Tam, C, Douglas, G, Cheah, CY, Ng, ZY, Rolfe, T, Mills, AK, Hamad, N, Cashman, H, Gleeson, M, Narayana, M & Hawkes, EA 2023, 'Outcomes in grade 3B follicular lymphoma: an international study led by the Australasian Lymphoma Alliance', Haematologica, vol. 108, no. 9, pp. 2444-2453. https://doi.org/10.3324/haematol.2022.281375

TY - JOUR

T1 - Outcomes in grade 3B follicular lymphoma

T2 - an international study led by the Australasian Lymphoma Alliance

AU - Barraclough, Allison

AU - England, James T.

AU - Villa, Diego

AU - Wight, Joel

AU - Hapgood, Greg

AU - Conn, Jason

AU - Doo, Nicole Wong

AU - Li, Eric Wenlong

AU - Gilbertson, Michael

AU - Shaw, Briony

AU - Bishton, Mark J.

AU - Saeed, Malik

AU - Ratnasingam, Sumita

AU - Abeyakoon, Chathuri

AU - Chong, Geoff

AU - Wai, Shin Hnin

AU - Ku, Matthew

AU - Lee, Hui Peng

AU - Fleming, Kathryn

AU - Tam, Constantine

AU - Douglas, Genevieve

AU - Cheah, Chan Y.

AU - Ng, Zi Yun

AU - Rolfe, Tukten

AU - Mills, Anthony K.

AU - Hamad, Nada

AU - Cashman, Helen

AU - Gleeson, Mary

AU - Narayana, Manjunath

AU - Hawkes, Eliza A.

N1 - Funding Information: This study was supported by a Royal Australasian College of Physicians Research Entry Scholarship to Allison Barraclough. Publisher Copyright: © 2023 Ferrata Storti Foundation.

PY - 2023/9

Y1 - 2023/9

N2 - Grade (G) 3B follicular lymphoma (FL) is a rare FL subtype which exists on a histological continuum between ‘low-grade’ (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.

AB - Grade (G) 3B follicular lymphoma (FL) is a rare FL subtype which exists on a histological continuum between ‘low-grade’ (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.

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U2 - 10.3324/haematol.2022.281375

DO - 10.3324/haematol.2022.281375

M3 - Article

C2 - 36815381

AN - SCOPUS:85170111841

SN - 0390-6078

VL - 108

SP - 2444

EP - 2453

JO - Haematologica

JF - Haematologica

IS - 9

ER -

Outcomes in grade 3B follicular lymphoma: an international study led by the Australasian Lymphoma Alliance

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