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Clinical characteristics and outcomes of follicular lymphoma patients with extranodal involvement: analysis of a series of 1090 cases in China

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Abstract

Background

Follicular lymphoma (FL) is the most common indolent B cell lymphoma in the world. The clinical features of extranodal involvement in FL were never extensively described.

Methods

We enrolled 1090 patients diagnosed as newly diagnosed FL at ten medical institutions in China from 2000 to 2020 and conducted this analysis and retrospectively explored clinical characteristics and outcomes of FL patients with extranodal involvement.

Results

400 (36.7%) patients with newly diagnosed FL had no extranodal involvement, 388 (35.6%) patients had one site of extranodal involvement, and 302 (27.7%) had two or more sites of involvement. Patients with >1 extranodal site had significantly worse PFS (p<0.001), as well as OS (p=0.010). The most common site of extranodal involvements was bone marrow (33%), followed by spleen (27.7%) and intestine (6.7%). In patients with extranodal involvement, multivariate Cox analysis found that male patients (p=0.016), poor performance status (p=0.035), increased LDH (p<0.001) and pancreas involvement (p<0.001) was associated with poor PFS, while the latter three factors were also associated with poor OS. Compared to patients with one site of extranodal involvement, patients with >1 site involvement (p=0.012) had 2.04-fold risk to develop POD24. In addition, multivariate Cox analysis found that the usage of rituximab was not associated with better PFS (p=0.787) or OS (p=0.191).

Conclusions

Our cohort is large enough to have statistical significance in FL patients with extranodal involvement. Male sex, increased LDH, poor performance status, >1 extranodal site, as well as pancreas involvement indicated useful prognostic factors in the clinical setting.

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Data availability

All relevant data and materials have been involved in the article. Further inquiries can be directed to the corresponding authors.

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Acknowledgements

We thank Chinese Workshop on Follicualr lymphoma. Especially, we also thank Prof. Tongyu Lin (Sichuan cancer hospital) for his kind supervision and support in designing and conducting this study.

Funding

This work was financially supported by the National Natural Science Foundation of China (82170180 granted for Bing Xu, 81800163 granted for Jie Zha, 81800196 and 81770161 granted for Zhiming Li), the Natural Science Foundation of Fujian Province (2020J011246 granted for Bing Xu, 2020GGB054 granted for Zhifeng Li), Xiamen Municipal Bureau of Science and Technology (3502Z20209003 granted for Bing Xu, 3502Z20209008 granted for Zhifeng Li) and Lymphoma Research Fund of Chinese Anti-Cancer Association (CORP-117 granted for Bing Xu).

Author information

Author notes

  1. Zhijuan Lin, Jie Zha, Shuhua Yi, Zhifeng Li, Lingyan Ping and Xiaohua He have contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China

    Zhijuan Lin, Jie Zha, Zhifeng Li, Liyuan Fan & Bing Xu

  2. Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China

    Zhijuan Lin, Jie Zha, Zhifeng Li, Liyuan Fan & Bing Xu

  3. State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Blood Diseases Hospital & Institute of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China

    Shuhua Yi & Lugui Qiu

  4. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China

    Lingyan Ping & Yuqin Song

  5. Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China

    Xiaohua He & Zhiming Li

  6. Department of Lymphoma, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China

    Haifeng Yu & Haiyan Yang

  7. Department of Lymphoma, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China

    Haifeng Yu & Haiyan Yang

  8. Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Zhong Zheng & Weili Zhao

  9. Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China

    Wei Xu & Li Wang

  10. Lymphoma Division, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China

    Feili Chen & Wenyu Li

  11. Shengli Clinical Medical College of Fujian Medical University, Department of Hematology, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China

    Ying Xie & Biyun Chen

  12. Department of Lymphoma, Tianjin Medical University Cancer Hospital, Tianjin, China

    Huilai Zhang

  13. Department of Hematology, The First Affiliated Hospital of USTC Anhui Provincial Hospital, Hefei, China

    Kaiyang Ding

Authors
  1. Zhijuan Lin
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  2. Jie Zha
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  3. Shuhua Yi
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  6. Xiaohua He
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  7. Liyuan Fan
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  8. Haifeng Yu
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  9. Zhong Zheng
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  10. Wei Xu
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  15. Li Wang
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  17. Wenyu Li
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  19. Weili Zhao
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  20. Lugui Qiu
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  21. Zhiming Li
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  22. Yuqin Song
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  23. Bing Xu
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Contributions

ZJL, ZFL, BX: took part in conception and design. ZJL, JZ, SHY, ZFL, LYP, XHH: involved in research performance. SHY, ZFL, LYP, XHH, LYF, HFY, ZZ, WX, FLC, YX, BYC, HLZ, WL, KYD, WYL, HYY, WLZ, LGQ, ZML, YQS, BX: took part in collection and assembly of clinical data. ZJL, JZ, BX: participated in data analysis and interpretation. ZJL, JZ and BX: involved in manuscript writing. ZJL, ZFL, ZML, YQS, BX: participated in study supervision. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Zhiming Li, Yuqin Song or Bing Xu.

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Lin, Z., Zha, J., Yi, S. et al. Clinical characteristics and outcomes of follicular lymphoma patients with extranodal involvement: analysis of a series of 1090 cases in China. Clin Transl Oncol 25, 1821–1829 (2023). https://doi.org/10.1007/s12094-023-03081-0

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