Abstract：
BACKGROUND: The difference between clinical characteristics and outcomes between follicular lymphoma grade 1-2 (FL1-2) and FL3a defined pathologically remains unclear, resulting in uncertainty how to treat FL3a. However, it may be crucial for clinicians to discriminate grade 3a and grade 1-2 for predicting prognosis and thus making treatment decisions.
METHODS: We compared 1403 patients with FL1-2 and 765 patients with FL3a diagnosed between January 2000 and December 2020 from fifteen centers nationwide in China to describe differences in clinical characteristics and outcomes.
RESULTS: Compared with FL1-2 patients, FL3a subgroup had a higher percentage of elderly patients (P = 0.003), and relatively more FL3a patients presented with increased levels of LDH (P < 0.0001) and higher Ki-67 indexs greater than 30% (P < 0.001). More FL3a patients were treated with CHOP ± R (P < 0.0001), and fewer were treated with the watchful-waiting approach (P < 0.0001). The results showed a higher incidence of relapse among FL3a patients, in which more patients underwent histological transformation (HT) when compared to FL1-2 (P = 0.003). 1470 (76.2%) patients of the entire cohort received R-CHOP therapy; survival analysis revealed that FL3a patients had a worse progression-free survival (PFS) rate than FL1-2 patients. Survival of FL3a patients with respect to FLIPI showed an inferior PFS in the intermediate and high-risk groups than FL1-2 patients. FL3a patients had a much worse prognosis than FL1-2 with or without progression of disease within 24 months (POD24). FL3a patients had higher likelihood of lymphoma-related death (LRD, P < 0.05), whereas the rates for non-LRD were comparable.
CONCLUSIONS: In conclusion, this study demonstrates a marked difference in clinical features and outcomes in FL3a patients compared with FL1-2 patients. The results highlight the need for applying therapeutic approaches distinct from FL1-2 when treating FL3a patients.
METHODS: We compared 1403 patients with FL1-2 and 765 patients with FL3a diagnosed between January 2000 and December 2020 from fifteen centers nationwide in China to describe differences in clinical characteristics and outcomes.
RESULTS: Compared with FL1-2 patients, FL3a subgroup had a higher percentage of elderly patients (P = 0.003), and relatively more FL3a patients presented with increased levels of LDH (P < 0.0001) and higher Ki-67 indexs greater than 30% (P < 0.001). More FL3a patients were treated with CHOP ± R (P < 0.0001), and fewer were treated with the watchful-waiting approach (P < 0.0001). The results showed a higher incidence of relapse among FL3a patients, in which more patients underwent histological transformation (HT) when compared to FL1-2 (P = 0.003). 1470 (76.2%) patients of the entire cohort received R-CHOP therapy; survival analysis revealed that FL3a patients had a worse progression-free survival (PFS) rate than FL1-2 patients. Survival of FL3a patients with respect to FLIPI showed an inferior PFS in the intermediate and high-risk groups than FL1-2 patients. FL3a patients had a much worse prognosis than FL1-2 with or without progression of disease within 24 months (POD24). FL3a patients had higher likelihood of lymphoma-related death (LRD, P < 0.05), whereas the rates for non-LRD were comparable.
CONCLUSIONS: In conclusion, this study demonstrates a marked difference in clinical features and outcomes in FL3a patients compared with FL1-2 patients. The results highlight the need for applying therapeutic approaches distinct from FL1-2 when treating FL3a patients.
摘要：
背景：滤泡性淋巴瘤1-2级（FL1-2）和FL3a病理定义的临床特征和结局之间的差异尚不清楚，导致如何治疗FL3a的不确定性。然而,对于临床医生来说,区分3a级和1-2级对于预测预后从而做出治疗决策可能是至关重要的.
方法：我们比较了2000年1月至2020年12月中国15个中心诊断的1403例FL1-2患者和765例FL3a患者的临床特征和结局差异。
结果：与FL1-2患者相比，FL3a亚组老年患者比例较高(P=0.003),相对更多的FL3a患者出现LDH水平升高（P<0.0001），Ki-67指数高于30%（P<0.001）。更多的FL3a患者接受CHOP±R治疗（P<0.0001），观察等待方法治疗较少(P<0.0001)。结果显示FL3a患者的复发率较高，与FL1-2相比，更多的患者经历了组织学转变（HT）（P=0.003）。整个队列中有1470例（76.2％）患者接受了R-CHOP治疗；生存分析显示，FL3a患者的无进展生存率（PFS）比FL1-2患者差。FL3a患者在FLIPI方面的生存率在中危和高危人群中的PFS低于FL1-2患者。FL3a患者的预后比FL1-2差很多，在24个月内有或没有疾病进展（POD24）。FL3a患者发生淋巴瘤相关死亡的可能性更高(LRD，P<0.05),而非LRD的比率相当。
结论：结论：这项研究表明,与FL1-2患者相比,FL3a患者的临床特征和结局存在显著差异.结果突出了在治疗FL3a患者时应用不同于FL1-2的治疗方法的需要。
方法：我们比较了2000年1月至2020年12月中国15个中心诊断的1403例FL1-2患者和765例FL3a患者的临床特征和结局差异。
结果：与FL1-2患者相比，FL3a亚组老年患者比例较高(P=0.003),相对更多的FL3a患者出现LDH水平升高（P<0.0001），Ki-67指数高于30%（P<0.001）。更多的FL3a患者接受CHOP±R治疗（P<0.0001），观察等待方法治疗较少(P<0.0001)。结果显示FL3a患者的复发率较高，与FL1-2相比，更多的患者经历了组织学转变（HT）（P=0.003）。整个队列中有1470例（76.2％）患者接受了R-CHOP治疗；生存分析显示，FL3a患者的无进展生存率（PFS）比FL1-2患者差。FL3a患者在FLIPI方面的生存率在中危和高危人群中的PFS低于FL1-2患者。FL3a患者的预后比FL1-2差很多，在24个月内有或没有疾病进展（POD24）。FL3a患者发生淋巴瘤相关死亡的可能性更高(LRD，P<0.05),而非LRD的比率相当。
结论：结论：这项研究表明,与FL1-2患者相比,FL3a患者的临床特征和结局存在显著差异.结果突出了在治疗FL3a患者时应用不同于FL1-2的治疗方法的需要。
