Long-Term Remissions of Patients With Follicular Lymphoma Grade 3 Treated With R-CHOP

The optimal management of patients with follicular lymphoma grade 3 (FLG3) is controversial. We analyzed 45 patients with FLG3 treated with first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). R-CHOP showed to be an effective first-line treatment for these patients, and provided extended PFS, comparable with outcomes observed in diffuse large B-cell lymphoma, particularly in subgroups with limited nodal disease. Background The optimal management of patients with follicular lymphoma Grade 3 (FLG3) is controversial. Patients and Methods This is a case series of 45 patients with FLG3 treated with first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and observed for an extended time interval. Results The overall response rate was 100% and the median progression-free survival (PFS) has not been reached, with a 3-year PFS of 70%; 14 (31%) patients relapsed, nearly all within 3 years. The baseline characteristic more strongly associated with a shorter PFS were lymph >4 node sites and presence of B symptoms. Three patients later progressed to diffuse large B cell lymphoma, all had baseline elevated serum lactate dehydrogenase level and high International Prognostic Index score. Median overall survival has not been reached. All 4 patients who later developed acute myeloid leukemia were older than 60 years at the time of start of therapy. Conclusion R-CHOP is an effective first-line treatment for patients with FLG3, and might provide extended PFS, comparable with outcomes observed in diffuse large B-cell lymphoma, particularly in subgroups with limited nodal disease.