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Follicular lymphoma is a relatively slow-growing cancer of the lymph system for which the 10-year survival rate is approximately 60% with standard treatment. However, it is important to know which persons are not as likely to do as well after receiving a standard treatment, so that additional or alternative treatment options can be made available for their consideration. It is also important to know which persons are likely to do well, so that they do not receive unnecessary additional or alternative treatments. Researchers in Italy recently identified a list of criteria that may help identify which persons may be at a high risk for a poor outcome after treatment for follicular lymphoma.

Follicular lymphoma is a type of

non-Hodgkin’s lymphoma, a cancer that is characterized by the presence of cancerous cells in the lymph system, which includes the blood vessels, lymph nodes, and organs such as the spleen, thymus, and tonsils. Non-Hodgkin’s lymphoma can start almost anywhere in the lymph system, and can then spread to other parts of the body. There are 2 categories of non-Hodgkin’s lymphoma: indolent and aggressive. Follicular lymphoma is of the indolent category, meaning that it is slow growing and less aggressive. Depending on the type and stage (extent of disease at diagnosis) of cancer, follicular lymphoma may be treated with no therapy (at first), radiation therapy alone, chemotherapy alone, or a combination of radiation and chemotherapy. Treatments using new chemotherapy drugs, a procedure called stem cell transplantation, and/or biologic therapies to help the immune system are also being studied in clinical trials.

Italian researchers reviewed the outcomes for 987 patients with follicular lymphoma to identify which persons did well and which did poorly after treatment. Based on these treatment outcomes, the researchers identified 6 criteria that were associated with a poor outcome: age older than 60 years; male gender; presence of symptoms such as fever, chills, loss of appetite, and weight loss; the spread of the cancer to more than 1 group of lymph nodes; and laboratory tests showing high levels of lactic dehydrogenase in the blood or an abnormal erythrocyte sedimentation rate. The researchers then used these criteria and the treatment outcome information to develop 3 categories of patients, defining their level of risk for dying of lymphoma. The

low-risk group had a 5-year survival of 90%, and a 10-year survival of 65%. The

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intermediate-risk group had a 5-year survival of 75% and a 10-year survival of 54%. The

high-risk group had a 5-year survival of only 38% and a 10-year survival of 11%. Patients having none or 1 of the criteria associated with a poor outcome were in the low-risk group; patients having 2 criteria were in the intermediate-risk group; and those having 3 or more criteria were in the high-risk group.

The researchers concluded that these criteria, or risk factors, may be useful in identifying which persons are likely to do well or do poorly after standard treatment for follicular lymphoma. Those persons identified as having a high risk of dying of lymphoma may wish to speak with their doctor about the risks and benefits of participating in a clinical trial or receiving newer forms of therapy, such as stem cell transplantation, new chemotherapy drugs, and/or biologic treatments. (

Blood, Vol 95, No 3, pp 783-789, 2000)

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