According to a recent article published in The New England Journal of Medicine, gene expression can help predict the prognosis of a patient with follicular lymphoma. Patients with a worse prognosis according to gene expression may consider more aggressive therapy, while those with a good prognosis may obtain long-term survival with less aggressive therapeutic approaches.

Follicular lymphoma is a type of non-Hodgkin’s lymphoma (NHL), which is a form of cancer that begins in the cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes and circulating immune cells. The main cells in the lymph system are lymphocytes, of which there are two types: B and T-cells. Each of these cells has a very specific function in aiding the body to fight infection. NHL is characterized by the excessive accumulation of atypical (cancerous) lymphocytes. These lymphocytes can crowd the lymph system and suppress the formation and function of other immune and blood cells. While NHL is categorized by the type of lymphocyte it involves, it is also further defined by the rate at which the cancer grows, based on the appearance of the cells under a microscope. Follicular lymphoma is a low-grade or indolent lymphoma that is slow growing.

With the advent of the field of genetics entering into the clinical management of cancer by revealing different prognoses among patients with various cancers, researchers are beginning to be able to further classify patients into specific subgroups according to the expression of their genes or genetic products (proteins). For example, through genetics, researchers now have an idea as to whether a patient with breast cancer may respond to specific chemotherapy agents or whether patients with different types of leukemia have a more or less aggressive type of leukemia. In the hopes of truly individualizing cancer treatment for patients, gene expression is being evaluated in several ongoing studies including multiple types of cancers.

Researchers affiliated with the National Cancer Institute (NCI) recently conducted a study to evaluate different expressions of genes and possible associations with survival in patients diagnosed with follicular lymphoma. This study included gene expression profiles of 191 specimens obtained during biopsy of patients diagnosed with follicular lymphoma. Patients had not yet received any treatment for their cancer. Results indicated that patients could be divided into four different subgroups according to gene expressions obtained from non-cancerous immune cells collected in the biopsy that correlated with duration of survival. The four groups had the following average length of survival: 13.6, 11.1, 10.8, and 3.9 years, regardless of other clinical variables.

The researchers concluded that gene expression can help determine the average duration of survival in patients diagnosed with follicular lymphoma. According to the gene expressions associated with the different survival times, optimal treatment choices can be made by patients and their healthcare providers. Patients diagnosed with follicular lymphoma may wish to speak with their physician about their individual risks and benefits of genetic testing or the participation in a clinical trial further evaluating genetic profiling or other individualized screening measures. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches are also performed at cancerconsultants.com on the patient’s behalf.

Reference: Dave S, Wright G, Tan B, et al. Prediction of survival in follicular lymphoma based on molecular features of tumor-infiltrating immune cells. The New England Journal of Medicine. 2004; 351:2159-2169.

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