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. 2003 Jul 7;89(1):36-42.
doi: 10.1038/sj.bjc.6601006.

Outcome of follicular lymphoma grade 3: is anthracycline necessary as front-line therapy?

I Chau  1 , R Jones, D Cunningham, A Wotherspoon, N Maisey, A R Norman, P Jain, L Bishop, A Horwich, D Catovsky
Affiliations

Outcome of follicular lymphoma grade 3: is anthracycline necessary as front-line therapy?

I Chau et al. Br J Cancer. .

Abstract

A grading system (grades 1-3) for follicular lymphoma (FL) is used in the WHO classification for lymphoid malignancies based on the absolute number of centroblasts in the neoplastic follicles. Grade 3 FL is further subdivided into 3a and 3b depending on the presence or absence of centrocytes. A total of 231 patients with FL, referred from 1970 to 2001, were identified from our prospectively maintained database. Original diagnostic materials were available for review on 215 patients and these were reclassified according to the WHO grading system. Follicular lymphoma grades 1, 2 and 3 accounted for 92, 68 and 55 patients, respectively. No significant overall survival (OS) differences were observed among FL grades 1-3 (log rank P=0.25) or between grades 3a and 3b (log rank P=0.20). No significant failure-free survival (FFS) differences were observed among FL grades 1-3 (log rank P=0.72) or between grades 3a and 3b (log rank P=0.11). First-line anthracyclines did not influence OS or FFS (log rank P=0.86, P=0.58, respectively) in patients with FL grade 3. There are long-term survivors among patients with FL grade 3 with a continuing risk of relapse. Anthracyclines did not appear to influence survival or disease relapses when given as front-line therapy in our series. The role of anthracyclines should be further evaluated in large randomised studies.

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Figures

Figure 1
Figure 1
Overall survival of follicular lymphoma by grade (years).
Figure 2
Figure 2
Cause-specific survival of follicular lymphoma by grade (years).
Figure 3
Figure 3
Failure-free survival of follicular lymphoma by grade.
Figure 4
Figure 4
Survival for grade 3a and 3b follicular lymphoma: (A) overall survival; (B) cause-specific survival; (C) failure-free survival.
Figure 5
Figure 5
Survival for patients with grade 3 follicular lymphoma receiving anthracyclines. (A) Overall survival for all patients with grade 3 follicular lymphoma. A1 group includes patients who received anthracyclines as their first-line treatment. Non-A1 group includes patients who did not receive anthracyclines as their first-line treatment. (B) Overall survival for patients with grade 3 follicular lymphoma excluding those with limited disease and received radiotherapy only as initial treatment.
Figure 6
Figure 6
Failure-free survival for patients with grade 3 follicular lymphoma receiving anthracyclines: (A) for all patients with grade 3 follicular lymphoma and (B) for patients with grade 3 follicular lymphoma excluding those with limited disease and received radiotherapy only as initial treatment.
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