CC BY-NC-ND 4.0 · South Asian J Cancer 2021; 10(02): 115-119
DOI: 10.1055/s-0041-1728226
Original Article: Leukemia – Lymphoma and Myeloma

Follicular Lymphoma in Young Adults: Study from a Regional Cancer Center in South India

A. H. Rudreshaa
1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
Shina Goyal
1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
D. Lokanatha
1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
Linu Abraham Jacob
1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
K. N. Lokesh
1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
Smitha Saldanha
1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
Bipinesh Sansar
1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
,
L. K. Rajeev
1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
› Author Affiliations
Funding None.

Abstract

Objective Follicular lymphoma (FL) is a disease of the elderly. It is postulated that younger patients have distinct tumor biology and treatment outcomes. Various lymphoma groups across the world have studied this to understand if young adults (YAs) need a different treatment approach. Our study fills the void in data from an Asian country on YA population with FL.

Patients and Methods We retrospectively analyzed young patients (age ≤40 years) diagnosed with FL at our center from 2012 to 2018. Their disease characteristics, treatment details, and outcomes were studied to examine any association between various parameters and survival.

Results There were 28 young FL patients included in our study that constituted 14.6% of FL cases (males: 53.5% and females: 46.5%). The median age at diagnosis was 36.5 years. Most of the patients presented in an advanced stage, 57% had extranodal involvement, and 39.3% had bone marrow involvement at the time of presentation. The most common chemotherapy regimen used was cyclophosphamide, vincristine, and prednisone. Half of them received chemoimmunotherapy and only 18% continued rituximab as maintenance therapy. The overall response rate was 92.9% (n = 26), and the remaining two patients had progressive disease while on treatment. The median progression free survival (PFS) was 6.1 years and median overall survival (OS) was not reached. On univariate analysis, extranodal disease was associated with a lower PFS (p = 0.06) and low hemoglobin showed a significant association with OS (p = 0.005). On multivariate analysis, none of the factors showed a significant association with survival.

Conclusion Most YAs present with advanced disease with a good response to treatment and favorable outcomes.



Publication History

Article published online:
23 September 2021

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  • References

  • 1 A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin’s lymphoma. The Non-Hodgkin’s Lymphoma Classification Project. Blood 1997; 89 (11) 3909-3918
  • 2 Link BK, Maurer MJ, Nowakowski GS. et al. Rates and outcomes of follicular lymphoma transformation in the immunochemotherapy era: a report from the University of Iowa/MayoClinic Specialized Program of Research Excellence Molecular Epidemiology Resource. J Clin Oncol 2013; 31 (26) 3272-3278
  • 3 Schmidt C, Fetscher S, Görg C. et al. Treatment of indolent lymphoma in Germany - results of a representative population-based survey. Clin Lymphoma Myeloma Leuk 2011; 11 (02) 204-211
  • 4 Nabhan C, Byrtek M, Taylor MD. et al. Racial differences in presentation and management of follicular non-Hodgkin lymphoma in the United States: report from the National LymphoCare Study. Cancer 2012; 118 (19) 4842-4850
  • 5 Solal-Céligny P, Roy P, Colombat P. et al. Follicular lymphoma international prognostic index. Blood 2004; 104 (05) 1258-1265
  • 6 Brice P, Bastion Y, Lepage E. et al. Comparison in low-tumor-burden follicular lymphomas between an initial no-treatment policy, prednimustine, or interferon alfa: a randomized study from the Groupe d’Etude des Lymphomes Folliculaires. Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol 1997; 15 (03) 1110-1117
  • 7 Ardeshna KM, Smith P, Norton A. et al. British National Lymphoma Investigation. Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: a randomised controlled trial. Lancet 2003; 362 (9383) 516-522
  • 8 Wahlin BE, Yri OE, Kimby E. et al. Clinical significance of the WHO grades of follicular lymphoma in a population-based cohort of 505 patients with long follow-up times. Br J Haematol 2012; 156 (02) 225-233
  • 9 Gangatharan SA, Maganti M, Kuruvilla JG. et al. Clinical characteristics and early treatment outcomes of follicular lymphoma in young adults. Br J Haematol 2015; 170 (03) 384-390
  • 10 Conconi A, Lobetti-Bodoni C, Montoto S. et al. Life expectancy of young adults with follicular lymphoma. Ann Oncol 2015; 26 (11) 2317-2322
  • 11 Casulo C, Day B, Dawson KL. et al. Disease characteristics, treatment patterns, and outcomes of follicular lymphoma in patients 40 years of age and younger: an analysis from the National Lymphocare Study†. Ann Oncol 2015; 26 (11) 2311-2317
  • 12 Summerfield GP, Wood KM, Taylor PR, White JM, Mounter PJ, Proctor SJ. Survival in young patients (less than 40 years) with follicular lymphoma: a population based study by the Scotland and Newcastle Lymphoma Group. Leuk Lymphoma 2004; 45 (06) 1149-1157
  • 13 Casulo C, Byrtek M, Dawson KL. et al. Early relapse of follicular lymphoma after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone defines patients at high risk for death: an analysis from the National LymphoCare Study. J Clin Oncol 2015; 33 (23) 2516-2522
  • 14 Maurer MJ, Habermann TM, Shi Q. et al. Progression-free survival at 24 months (PFS24) and subsequent outcome for patients with diffuse large B-cell lymphoma (DLBCL) enrolled on randomized clinical trials. Ann Oncol 2018; 29 (08) 1822-1827
  • 15 Gogia A, Raina V, Kumar L, Sharma A, Sharma MCh, Mallick SR. Follicular lymphoma: an institutional analysis. Asian Pac J Cancer Prev 2017; 18 (03) 681-685
  • 16 Gupta AA, Edelstein K, Albert-Green A, D’Agostino N. Assessing information and service needs of young adults with cancer at a single institution: the importance of information on cancer diagnosis, fertility preservation, diet, and exercise. Support Care Cancer 2013; 21 (09) 2477-2484
  • de Juan VC, Provencio M, Codina JG, Abreu DR, Rueda A, Arroyo RG, et al.916P- Survival in young adults diagnosed with follicular lymphoma in a national registry from the Spanish Lymphoma Oncology Group. Ann Oncol. 2016 Oct 1;27:vi316