Follicular lymphoma (FL) 3B is considered an aggressive lymphoma, however recent studies have challenged this paradigm. Additional controversy involves the clinical implication of pure FL3B (FL3Bp) vs FL3B with concurrent diffuse large B cell lymphoma (DLBCL) (FL3Bc). To address these questions, we performed a pooled study of the MER and LEO cohorts comparing 464 newly diagnosed, R-CHOP-treated patients with FL1-2 (n = 216), FL3A (n = 170), FL3B (n = 78) and 739 DLBCL. Among FL3B patients, 19 (24%) had FL3Bc and 59 (76%) FL3Bp. Baseline characteristics and outcomes were similar between the two FL3B subtypes. Compared to FL1-3A, FL3B showed similar clinical features, except for a lower tumor burden. After R-CHOP, FL1-2 patients had an inferior event-free survival (EFS) than those with FL3B, whereas there was no difference with FL3A. Survival was similar across the FL grades. Although FL1-2 patients failed to achieve EFS24 more frequently than FL3B and FL3A, FL3B patients who failed EFS24 had three-fold higher risk of subsequent mortality than other FLs. At 5-year follow-up FL3B patients had twice the risk of relapse with an aggressive subtype than those with FL1-2 and FL3A. Compared to DLBCL, FL3B patients had more favorable clinical features, but similar outcomes to GCB subtype. Our data suggest that most FL3B have a good outcome, while a subset has an aggressive behavior.
滤泡性淋巴瘤3B级（FL3B）传统上被视为侵袭性淋巴瘤，但近期研究对这一观点提出了挑战。另一争议点在于单纯性FL3B（FL3Bp）与伴随弥漫性大B细胞淋巴瘤的FL3B（FL3Bc）的临床意义差异。为探究这些问题，我们对MER和LEO队列进行了汇总分析，共纳入464例接受R-CHOP方案治疗的新诊断患者（包括FL1-2级216例、FL3A级170例、FL3B级78例）及739例DLBCL患者。FL3B患者中，19例（24%）为FL3Bc，59例（76%）为FL3Bp。两种FL3B亚型的基线特征和临床结局相似。与FL1-3A级相比，FL3B除肿瘤负荷较低外，其他临床特征相似。R-CHOP治疗后，FL1-2级患者的无事件生存期（EFS）较FL3B级患者更差，而与FL3A级无显著差异。各分级FL患者的总体生存率相近。虽然FL1-2级患者未达到24个月无事件生存（EFS24）的比例高于FL3B和FL3A级，但未达到EFS24的FL3B患者后续死亡风险是其他FL分级患者的三倍。在5年随访中，FL3B患者发生侵袭性亚型复发的风险是FL1-2级和FL3A级患者的两倍。与DLBCL相比，FL3B患者临床特征更有利，但其结局与GCB亚型DLBCL相似。我们的数据表明，多数FL3B患者预后良好，但其中部分病例具有侵袭性临床行为。
肿瘤(癌症)患者之家