Follicular large cell lymphoma: An aggressive lymphoma that often presentswith favorable prognostic features

It is debated whether follicular large cell lymphoma (FLCL) has a clinical behavior that is distinct from indolent follicular lymphomas, and whether t here is a subset of patients who can be potentially cured. We report here o ur experience with 100 FLCL patients treated at our institution since 1984 with three successive programs. We evaluated the predictive value of pretre atment clinical features, including two risk models, the Tumor Score System and the International Prognostic Index (IPI), With a median follow-up of 6 7 months, the 5-year survival is 72% and the failure-free survival (FFS) is 67%, with a possible plateau in the FFS curve, particularly for patients w ith stage I-III disease. Features associated with shorter survival included age greater than or equal to 60, elevated lactic dehydrogenase (LDH) or be ta-2-microglobulin (beta 2M), advanced stage, and bone marrow involvement. Stage III patients had significantly better survival than stage IV patients (P < .05), By the IPI and Tumor Score System, 80% of the patients were in the lower risk groups; both systems stratified patients into prognostic gro ups. Patients with FLCL have clinical features and response to treatment si milar to that reported for diffuse large cell lymphoma. Prognostic risk sys tems for aggressive lymphomas are useful for FLCL. A meaningful fraction of patients may possibly be cured when treated as aggressive lymphomas. (C) 1 999 by The American Society of Hematology.