Classification And Prognosis

The follicular lymphomas are the second most common subtype of indolent non-Hodgkin's lymphoma (NHL), representing about 25-30% of NHL. In the working formulation, these tumors were subclassified into follicular small cleaved cell, follicular mixed small and large cell, and follicular large cell, based on the number of larger cells per high-powered field.1 In the more recent Revised European American Lymphoma2 and the subsequent, universally adopted World Health Organization (WHO) classifications,34 the nomenclature became grade I, grade II, and grade III, respectively. Grade III has been further subdivided into grade III A or grade III B, reflecting the presence of centroblasts (III A) or sheets of centroblasts (III B). A clinically meaningful difference in outcome between grade I and II has not been uniformly demonstrable.5-8

The conduct of clinical trials has been facilitated by the availability of prognostic scoring systems910 and standardized response criteria.11 The International Prognostic Index, originally developed for diffuse large B-cell lymphoma,9 can distinguish risk groups in patients with follicular lymphoma as well.1213 However, better separation among the prognostic subsets may be afforded by the new Follicular Lymphoma International Prognostic Index10 that uses stage, age, number of involved nodal sites, lactate dehydrogenase (LDH), and hemoglobin to identify low- (0-1 adverse factor), intermediate- (2 factors), or high-risk (>3 factors) patients.

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