FOLLICULAR LYMPHOMAS: Do Histologic Subtypes Predict Outcome? - 09/09/11
Résumé |
The topic of follicular lymphomas, and more specifically, the relationship of histologic subtypes of follicular lymphomas to outcome, has periodically been the focus of extensive debate.1, 7, 16 The results of such discussions are important to practicing clinicians with regard to patient care by setting expectations of prognosis and guiding therapy. Currently, the Working Formulation system of classifying non-Hodgkin's lymphomas provides the framework from which clinicians translate lymphoma histologic subtypes into outcome expectations and therapeutic strategies.26 According to the Working Formulation, patients with low-grade histologic subtypes are generally thought to be incurable and are treated for palliation of symptoms related to lymphoma.4, 10 Low-grade histologic subtypes of follicular lymphoma include follicular small cleaved-cell and follicular mixed large- and small-cell types.26 Intermediate and high-grade histologic subtypes, on the other hand, are known to be potentially curable and are treated with aggressive doxorubicin-containing combination chemotherapy.6, 24 Follicular large-cell lymphoma is currently classified as an intermediate-grade histology and is usually treated accordingly with curative intent.2, 6, 26 Some investigators have previously argued that follicular mixed large- and small-cell lymphomas also have a potential for cure and should also be treated with doxorubicin-containing chemotherapy.1, 17, 21
Recently, a group of internationally known expert hematopathologists proposed a new classification system, the Revised European-American Lymphoma Classification (REAL).3, 9 In that system, the distinction between follicular lymphoma subtypes is minimized. The authors suggest the term grade be used instead of distinct names, to better reflect the reality of a cytologic continuum.9 These investigators recognize that pathologists cannot reproducibly determine the proportion of large cells and, therefore, cannot reproducibly determine the histologic subtype of follicular lymphomas. This consensus decision to lump follicular subtypes will surely prompt another debate with regard to outcome relative to histology. In an attempt to test the clinical utility of the REAL proposal to lump follicular lymphoma subtypes, and to provide data for that debate, we have analyzed data from the Southwest Oncology Group (SWOG) including 389 patients with follicular lymphomas followed for up to 25 years.
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| Address reprint requests to Janet C. Graff, Southwest Oncology Group, Operations Office, 14980 Omicron Drive, San Antonio, TX 78245–3217 This work was written for the Southwest Oncology Group, San Antonio, Texas, and was supported in part by the following PHS Cooperative Agreement Grants awarded by the National Cancer Institute, DHHS: CA-13612, CA-38926, CA-46282, and CA-32102 |
Vol 11 - N° 5
P. 893-900 - octobre 1997 Retour au numéro
Article précédent
- MISTAKEN DIAGNOSES OF HODGKIN'S DISEASE
- Rita M. Braziel, Kevin Oyama
- OVERVIEW OF TREATMENT OF LOCALIZED LOW-GRADE LYMPHOMAS
- Michael P. Mac Manus, Richard T. Hoppe
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