Subsets of follicular lymphoma 3B have divergent outcomes: results from the prospective multicenter MER and LEO cohorts

Patrizia Mondello; Brianna Negaard; Andrew L Feldman; Brian K Link; Carla Casulo; Dai Chihara; David Russler-Germain; Jason Romancik; Caitlin Gribbin; Sara Haddadi; Eric Mou; Ivana N Micallef; Patrick B Johnston; Joseph Novak; Yucai Wang; Rebecca L King; Anne J Novak; Thomas M Habermann; Peter Martin; Brad Kahl; Grzegorz S Nowakowski; Loretta J Nastoupil; James R Cerhan; Christopher R Flowers; Izidore S Lossos; Richard W Burack; Matthew J Maurer; Stephen M Ansell

doi:10.1038/s41408-025-01347-0

Back

Subsets of follicular lymphoma 3B have divergent outcomes: results from the prospective multicenter MER and LEO cohorts

Journal article

Open access

Peer reviewed

Subsets of follicular lymphoma 3B have divergent outcomes: results from the prospective multicenter MER and LEO cohorts

Patrizia Mondello, Brianna Negaard, Andrew L Feldman, Brian K Link, Carla Casulo, Dai Chihara, David Russler-Germain, Jason Romancik, Caitlin Gribbin, Sara Haddadi, …

Blood cancer journal (New York), Vol.15(1), 134

08/08/2025

DOI: 10.1038/s41408-025-01347-0

PMCID: PMC12334739

PMID: 40781119

Files and links (1)

url

https://doi.org/10.1038/s41408-025-01347-0View

Published (Version of record) Open Access

Abstract

Follicular lymphoma (FL) 3B is considered an aggressive lymphoma, however recent studies have challenged this paradigm. Additional controversy involves the clinical implication of pure FL3B (FL3Bp) vs FL3B with concurrent diffuse large B cell lymphoma (DLBCL) (FL3Bc). To address these questions, we performed a pooled study of the MER and LEO cohorts comparing 464 newly diagnosed, R-CHOP-treated patients with FL1-2 (n = 216), FL3A (n = 170), FL3B (n = 78) and 739 DLBCL. Among FL3B patients, 19 (24%) had FL3Bc and 59 (76%) FL3Bp. Baseline characteristics and outcomes were similar between the two FL3B subtypes. Compared to FL1-3A, FL3B showed similar clinical features, except for a lower tumor burden. After R-CHOP, FL1-2 patients had an inferior event-free survival (EFS) than those with FL3B, whereas there was no difference with FL3A. Survival was similar across the FL grades. Although FL1-2 patients failed to achieve EFS24 more frequently than FL3B and FL3A, FL3B patients who failed EFS24 had three-fold higher risk of subsequent mortality than other FLs. At 5-year follow-up FL3B patients had twice the risk of relapse with an aggressive subtype than those with FL1-2 and FL3A. Compared to DLBCL, FL3B patients had more favorable clinical features, but similar outcomes to GCB subtype. Our data suggest that most FL3B have a good outcome, while a subset has an aggressive behavior.

Adult

Aged

Aged, 80 and over

Antineoplastic Combined Chemotherapy Protocols - therapeutic use

Cyclophosphamide - administration & dosage

Cyclophosphamide - therapeutic use

Doxorubicin - administration & dosage

Doxorubicin - therapeutic use

Female

Humans

Lymphoma, Follicular - classification

Lymphoma, Follicular - drug therapy

Lymphoma, Follicular - mortality

Lymphoma, Follicular - pathology

Lymphoma, Large B-Cell, Diffuse - drug therapy

Lymphoma, Large B-Cell, Diffuse - mortality

Lymphoma, Large B-Cell, Diffuse - pathology

Male

Middle Aged

Prednisone - administration & dosage

Prednisone - therapeutic use

Prognosis

Prospective Studies

Rituximab - therapeutic use

Treatment Outcome

Vincristine - administration & dosage

Vincristine - therapeutic use

Details

Title: Subtitle: Subsets of follicular lymphoma 3B have divergent outcomes: results from the prospective multicenter MER and LEO cohorts
Creators: Patrizia Mondello - Mayo Clinic in Arizona
Brianna Negaard - Mayo Clinic
Andrew L Feldman - Mayo Clinic in Arizona
Brian K Link - University of Iowa
Carla Casulo - University of Rochester
Dai Chihara - The University of Texas MD Anderson Cancer Center
David Russler-Germain - Washington University in St. Louis
Jason Romancik - Emory University
Caitlin Gribbin - Cornell University
Sara Haddadi - University of Miami
Eric Mou - University of Iowa
Ivana N Micallef - Mayo Clinic in Arizona
Patrick B Johnston - Mayo Clinic in Arizona
Joseph Novak - Mayo Clinic in Arizona
Yucai Wang - Mayo Clinic in Arizona
Rebecca L King - Mayo Clinic in Arizona
Anne J Novak - Mayo Clinic in Arizona
Thomas M Habermann - Mayo Clinic in Arizona
Peter Martin - Cornell University
Brad Kahl - Washington University in St. Louis
Grzegorz S Nowakowski - Mayo Clinic in Arizona
Loretta J Nastoupil - The University of Texas MD Anderson Cancer Center
James R Cerhan - Mayo Clinic in Florida
Christopher R Flowers - The University of Texas MD Anderson Cancer Center
Izidore S Lossos - Sylvester Comprehensive Cancer Center
Richard W Burack - University of Rochester
Matthew J Maurer - Mayo Clinic in Florida
Stephen M Ansell - Mayo Clinic in Arizona
Resource Type: Journal article
Publication Details: Blood cancer journal (New York), Vol.15(1), 134
DOI: 10.1038/s41408-025-01347-0
PMID: 40781119
PMCID: PMC12334739
NLM abbreviation: Blood Cancer J
ISSN: 2044-5385
eISSN: 2044-5385
Publisher: SPRINGERNATURE
Grant note: U01 CA195568 / NCI NIH HHS 2021YIA-3392116949 / American Society of Clinical Oncology (ASCO) P50 CA97274 / U.S. Department of Health & Human Services | NIH | National Cancer Institute (NCI) 1K08CA279652 / U.S. Department of Health & Human Services | NIH | National Cancer Institute (NCI) LSRMP #818463 / Lymphoma Research Foundation (LRF)
Language: English
Date published: 08/08/2025
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Epidemiology; Internal Medicine
Record Identifier: 9984945085102771

Metrics

2 Record Views