Clinical Features And Prognostic Factors Of 67 Patients With Follicular Lymphoma

Objective: To investigate the clinical festures and related prognostic factors of patients with follicular lymphoma.Methods: The clinical data of patients with follicular lymphoma diagnosed in our hospital from January 2012 to August 2020 were retrospectively analyzed.The clinical data including gender,age,clinical stage,pathological grade,related laboratory indexes,immunohistochemical results,clinical efficacy,and early progression.The clinical characteristics and related prognostic factors were statistically analyzed.Results: 67 follicular lymphoma patients,including 39 males and 28 females,male :female = 1.39 : 1;The median age was 57(25-86)years old,with an average age of 56.7years old.The median follow-up time was 32(2– 92)months,and the average follow-up time was 35 months.The median OS and PFS were not reached.Most patients had superficial lymph node enlargement as the first symptom,followed by the corresponding symptoms caused by extranodal organ involvement.According to Ann Arbor stage,71.6% of patients were in stage III-IV;17.9 % of patients had B symptoms at the beginning of treatment;In pathological grading,49.3% of the patients were grade 1–2,37.3% of patients were grade 3,and 13.4% of the patients were accompanied by large B cell transformation.26.9% of patients had bone marrow involvement at the first visit.72.6% patients reached CR;FLIPI score≥3 points in 35.8% patients;23.9% patients had FLIPI-2 score≥3 points;According to PRIMA-PI,38.8% of patients were at high risk.Immunohistochemical phenotype of 62 patients with complete immunohistochemical results: Ki-67>30 % accounted for 56.7 %,bcl-2 positive patients accounted for 89.6%,bcl-6 positive patients accounted for 80.6%,CD5 positive patients accounted for 11.9%,CD10 positive patients accounted for 67.7 %,all patients expressed CD20.29.9% of patients had early disease progression as at 31 October 2020.The univariate analysis of gender,age,clinical stage,pathological grade and related laboratory indexes showed that age≥60 years old,pathology with large B cell transformation,bone marrow involvement,LDH increase,POD24 occurrence,untreated CR,high risk of FLIPI and high risk of FLIPI-2 were the adverse prognostic factors of OS(P < 0.05).The OS of patients with negative Ki-67 was better than that of patients with positive Ki-67,but the difference between the two was not statistically significant(0.05 < P < 0.1).The risk factors of PFS were age ≥ 60 years old,pathology with large B cell transformation,bone marrow involvement,elevated LDH,occurrence of POD24,initial failure to achieve CR and high risk of FLIPI(P < 0.05);The PFS of patients with FLIPI-2 score ≥ 3 and Ki-67 positive was worse than those of patients with FLIPI-2 score < 3 and Ki-67 negative,but there was no significant difference(0.05 < P < 0.1).Multivariate analysis showed that POD24 was an independent risk factor for OS;Pathological grading was an independent risk factor for PFS.Conclusion:1.FL is more common in middle-aged and elderly patients,with a median age of 57 years old,younger than those in Europe and the United States.Most patients are in the advanced stage.Most patients seek medical attention due to enlarged lymphnodes,and a few patients have B symptoms.Some patients have bone marrow involvement,and most patients express CD20,CD5 positive patients are rare.FL patients have relatively good prognosis and longer median survival time.2.In the era of rituximab,observation and waiting are still applicable to asymptomatic FL patients with low tumor burden.3.Age ≥ 60 years old,pathology with large B-cell transformation,bone marrow involvement,LDH elevation,POD24 occurrence,failed to reach CR after initial treatment,high-risk scores of FLIPI and FLIPI-2 are the poor prognostic factors of OS,and POD24 occurrence is the independent risk factor.4.Age ≥ 60 years,pathology with large B cell transformation,bone marrow involvement,elevated LDH,POD24 occurrence,failed to reach CR after initial treatment,high risk of FLIPI are poor prognostic factors for PFS,and pathology with large B cell transformation is an independent risk factor.