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. 2018 Oct-Dec;40(4):343-353.
doi: 10.1016/j.htct.2018.02.004. Epub 2018 Apr 18.

Characteristics of follicular and mantle cell lymphoma in Brazil: prognostic impact of clinical parameters and treatment conditions in two hospitals

Guilherme Rossi Assis-Mendonça  1 , André Henrique Crepaldi  2 , Márcia Torresan Delamain  1 , Adriana Helena Moreira  2 , Felipe D'Almeida Costa  2 , Vladmir Cláudio Cordeiro de Lima  2 , Cármino Antonio de Souza  1 , Fernando Augusto Soares  2 , José Vassallo  1   2
Affiliations

Characteristics of follicular and mantle cell lymphoma in Brazil: prognostic impact of clinical parameters and treatment conditions in two hospitals

Guilherme Rossi Assis-Mendonça et al. Hematol Transfus Cell Ther. 2018 Oct-Dec.

Abstract

Objective: Follicular and mantle cell lymphoma are low-grade B-cell malignancies that lack good responses to chemoimmunotherapy. This study aimed to assess retrospectively clinicopathological features and to determine independent prognostic factors for follicular and mantle cell lymphoma patients treated at two Brazilian medical centers: the Hematology and Hemotherapy Center of the Universidade Estadual de Campinas (Unicamp), a public university hospital, and AC. Camargo Cancer Center, a specialized cancer center.

Methods: Two hundred and twenty-seven follicular and 112 mantle cell lymphoma cases were diagnosed between 1999 and 2016. Archived paraffin blocks were retrieved and reviewed. Corresponding demographics and clinical data were recovered from medical charts. Outcome analyses considered both overall and event-free survival.

Results: For follicular lymphoma treated with the R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, prednisone) and R-CVP (rituximab, cyclophosphamide, vincristine sulfate, prednisone) regimens, both B-symptoms (p-value < 0.01 for overall and event-free survival) and high-risk Follicular Lymphoma International Prognostic Index (p-value < 0.01 for overall survival) were independently associated to worse prognosis. Maintenance with rituximab improved the prognosis (p-value < 0.01 for overall survival). For mantle cell lymphoma, B-symptoms (p-value = 0.03 for overall survival and event-free survival) and bone marrow infiltration (p-value = 0.01 for overall survival) independently predicted reduced survival, and rituximab at induction increased both event-free and overall survival (p-value < 0.01 in both analyses). Combinations of these deleterious features could identify extremely poor prognostic subgroups. The administration of rituximab was more frequent in the AC. Camargo Cancer Center, which was the institution associated with better overall survival for both neoplasias.

Conclusion: This study represents the largest cohort of follicular and mantle cell lymphoma in South America thus far. Some easily assessable clinical variables were able to predict prognosis and should be considered in low-income centers. In addition, the underuse of rituximab in the Brazilian public health system should be reconsidered in future health policies.

Keywords: Follicular lymphoma; Histopathology; Mantle cell lymphoma; Prognosis.

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Figures

Fig. 1
Fig. 1
Pathological assessment of follicular lymphoma (FL) and mantle cell lymphoma (MCL). (A–C) Histological grading of FL: Grades 1 (A), 2 (B) and 3A (C) showing increasing percentages of centroblasts in comparison with centrocytes. (D–F) Patterns of MCL proliferation: nodular (D), mantle zone (E) and diffuse (F). (G–I) Cytological variants of MCL: classic (G), small cell (H) and blastoid (I).
Fig. 2
Fig. 2
Survival curves of follicular lymphoma (FL) and mantle cell lymphoma (MCL) patients. (A) and (B): Overall (A) and event-free (B) survival of FL cases treated with R-CHOP/R-CVP, compared with CHOP/CVP-treated patients. (C) and (D): Overall (C) and event-free (D) survival of MCL patients, grouped according to rituximab administration at induction therapy. (E) and (F): Overall (E) and event-free (F) survival of FL cases treated with R-CHOP/R-CVP, according to the presence of B-symptoms and/or high-risk FLIPI. (G) and (H): Overall (G) and event-free (H) survival of MCL treated with any drug regimen, grouped based on the presence of B-symptoms and/or bone marrow infiltration. All p-values were obtained using log-rank statistics.
Fig. 3
Fig. 3
Overall survival of (A) follicular and (B) mantle cell lymphomas regarding institution of origin. All p-values were obtained using log-rank statistics.
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