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Clinical characteristics and prognosis of patients with co-existing follicular lymphoma and diffuse large B-cell lymphoma components in rituximab era

  • Original Article – Clinical Oncology
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Abstract

Purpose

This single-centre study aimed to determine the clinicopathological characteristics and prognosis for patients with co-existing FL and DLBCL components (FL/DLBCL).

Methods

We retrospectively analysed the clinical characteristics and prognosis of patients diagnosed with FL/DLBCL (n = 56) and with pure FL (n = 260) or de novo DLBCL (n = 812) (controls) between January 2013 and December 2021.

Results

The median age of patients with FL/DLBCL was 52 years. The amount of the DLBCL component ranged from 5 to 95%. Among the 56 FL/DLBCL cases analysed, 67.9% were of germinal centre B-cell (GCB) origin, 26.8% non-GCB origin, and 5.3% were unclassified. The clinical features of patients with FL/DLBCL were intermediate, falling between those of FL and DLBCL. Propensity-score matching was performed for patients with similar baseline characteristics who were receiving the rituximab plus cyclophosphamide, doxorubicin or epirubicin, vindesine, and prednisone (R-CHOP) regimen. Patients with FL/DLBCL showed inferior outcomes compared to those with FL, with a lower complete remission (CR) rate, progression-free survival (PFS), and overall survival (OS). Bone marrow involvement and B symptoms were identified as independent adverse prognostic factors for PFS among patients with FL/DLBCL. Patients with FL/DLBCL presented a lower CR rate and PFS but similar OS to those with DLBCL when receiving the R-CHOP regimen.

Conclusion

Patients with FL/DLBCL showed inferior treatment response and survival than those with pure FL and had a lower CR rate and PFS, but similar OS to those with DLBCL in the rituximab era.

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Data availability statement

The data that support the findings of this study are included in this article. Further enquirers can be directed to the corresponding author via e-mail.

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Acknowledgements

We would like to thank Editage (www.editage.cn) for English language editing.

Funding

This study was supported by the Startup Fund for scientific research, Fujian Medical University (Grant number: 2020QH1079), National Natural Science Foundation of China (81870135, U2005204, 82000142), National Key Clinical Specialty Discipline Construction Program (2021-76), Fujian Provincial Clinical Research Center for Hematological Malignancies (2020Y2006).

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Author notes

  1. Yi Chen and Luting Luo made the same contributions and are co-first authors.

Authors and Affiliations

  1. Fujian Medical University Union Hospital, Fujian Provincial Key Laboratory on Hematology, Fujian Institute of Hematology, Fuzhou, Fujian, China

    Yi Chen, Luting Luo, Lushan Chen, Xiaoyun Zheng, Xiaozhu Yang, Zhihong Zheng, Jing Zheng, Tingbo Liu, Ting Yang & Jianda Hu

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  1. Yi Chen
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  2. Luting Luo
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  3. Lushan Chen
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Corresponding author

Correspondence to Jianda Hu.

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The authors declared no conflict of interests.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Fujian Medical University Union Hospital (protocol code 2022KY047).

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All patients provided written consent for treatment.

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Chen, Y., Luo, L., Chen, L. et al. Clinical characteristics and prognosis of patients with co-existing follicular lymphoma and diffuse large B-cell lymphoma components in rituximab era. J Cancer Res Clin Oncol 149, 2311–2318 (2023). https://doi.org/10.1007/s00432-022-04381-8

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