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

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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 languageEnglish
Pages (from-to)2444-2453
Number of pages10
Issue number9
Publication statusPublished - Sept 2023

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