FOLLICULAR LARGE-CELL LYMPHOMA TREATED WITH INTENSIVE CHEMOTHERAPY - AN ANALYSIS OF 89 CASES INCLUDED IN THE LNH87 TRIAL AND COMPARISON WITH THE OUTCOME OF DIFFUSE LARGE B-CELL LYMPHOMA

Purpose: The aims of this study were as follows: (1) to analyze clinic al, histopathologic characteristics, treatment outcome, and prognostic factors of patients with follicular large-cell lymphoma (FLCL); and ( 2) to compare them with those of patients with diffuse large B-cell ly mphoma (DLCL) treated in the same therapeutic trial. Patients and Meth ods: Eighty-wine FLCL patients who were histologically reviewed and wh o received an intensive chemotherapy regimen according to the LNH 87 p rotocol were analyzed and compared with 1,096 B-cell DLCL patients inc luded in the same protocol. Results: After intensive induction treatme nt 59 patients (67%) achieved a complete remission (CR), Estimated 5-y ear survival was 59%, and estimated 5-year freedom from progression (F FP) was 39%. Prognostic factors associated with shorter FFP were age g reater than 60 years (P = .02), advanced clinical stage (P = .01), abn ormal lactic dehydrogenase (LDH) revel (P = .02), abnormal beta-2 micr oglobulin (P = .02), B symptoms (P = .03), bone marrow involvement (P = .04), and high expression of bcl-2 protein (P = .05). When compared with B-cell DLCL patients, FLCL patients were younger (P = .02), had a better Eastern Cooperative Oncology Group (ECOG) status (P = .05), le ss bulky mass (P = .04), more advanced clinical stages (P < .001), and more bone marrow involvment (P = .02). No significant difference was observed between FLCL and DLCL patients for response to therapy (67% v 67% of: CR), 5-year overall survival (58% v 51%), 5-year disease-free survival (53% v 57%), or FFP survival (39% v 43%). Conclusion: FLCL p atients have a favorable response rate and survival when treated with intensive chemotherapy. Their outcome is similar to that of B-cell DLC L patients, and a long-term FFP is observed for a substantial number o f patients. Some adverse prognostic Factors (including those of the In ternational Prognostic Index, bone marrow involvement, and beta-2 mitr oglobulin) have been identified to define a subset of patients who req uire other therapeutic approach. (C) 1997 by American Society of Clini cal Oncology.