follicular lymphoma survival | Follicular lymphomas

Follicular lymphomas

 
Summary
Follicular lymphoma is the second most common entity among non-Hodgkin lymphomas after large-cell diffuse B lymphomas. The median age for diagnosis is 65 years, with a discrete female predominance [1]. Considered a indolent form usually not curable, its clinical evolution is heterogeneous and most often marked by a succession of relapses. Patient management reflects this heterogeneity, ranging from therapeutic forbearance to the allograft of hematopoietic stem cells. The arrival of targeted treatments with anti-CD20 monoclonal antibodies in the late 1990 altered therapeutic strategies over the past decade, with a positive impact on progression-free survival (PFS) and overall patient survival [2].

Follicular lymphomas 6
L.M.. Fornecker
L.M.. Fornecker (
) – Oncology and Hematology Department, Hautepierre Hospital,
1, Avenue Molière, 67200 Strasbourg
E-mail: luc-matthieu.fornecker@chru-strasbourg.fr
Under the direction of Pauline Brice and Catherine Taylor, therapeutic News in the
Lymphoma.
ISBN: 978-2-8178-0370-8, © Springer-Verlag Paris 2013
Introduction
Follicular lymphoma is the second most common entity
Among non-Hodgkin lymphomas after diffuse B lymphomas with large
Cells. The median age for diagnosis is 65 years, with a discreet predominance
Women [1]. Considered a indolent form usually
Not curable, its clinical evolution is heterogeneous and most often marked
By a succession of relapses. Taking care of patients reflects this heterogeneity,
From therapeutic forbearance to the allograft of stem cells
Haematopoietic. The arrival of targeted treatments with monoclonal antibodies
Anti-CD20 at the end of the years 1990 modified the Therapeutic Strategies
Over the past decade, with a positive impact on survival without
Progression (PFS) and overall patient survival [2].

Diagnosis
The diagnosis is based on the WHO Anatomopathologic classification
Updated in 2008. The normal ganglionic architecture is erased by a
Tumor proliferation that most often retains follicular architecture,
Consisting of centrocytes and centroblasts in varying proportions. The proliferation
Tumor can also take a diffuse architecture. Based on
Percentage of follicular structures, four types of tumor architectures
Are described: follicular, follicular and diffuse, follicular focal and
Diffuse. The proportion of centroblasts allows to establish the rank, the proliferation
of grade 1-2 containing less than 15 centroblasts per field. Grade 3
is subdivided according to the presence (grade 3a) or not (Grade 3b) of Centrocytes.
In immunohistochemistry, the cells have a phenotype B of the centre type
Germ: CD10 +, BCL2 +, and BCL6 +. The CD21/CD23 marking allows
To identify the dendritic follicular cell network. The expression of BCL2 84 therapeutic News in Lymphomas
is detected in more than 80% of the cases of follicular lymphoma of grade 1-2.
The proliferation index is usually low, < 20% in grades 1-2; However, it is higher, > 20%, in Grade 3 proliferations. At the level
Cytogenetics, follicular lymphoma is characterized by the presence of a
T (14; 18) (Q32; q21) responsible for a hyperexpression of the BCL2 protein,
Placing the BCL2 gene under the control of the heavy chain gene promoter
of Immunoglobulins. BCL2 is a physiologically antiapoptotique gene
Not expressed in normal germ centers. Without being specific, this
Translocation is present in 90% of follicular lymphomas of grade 1-2.

Other cytogenetic anomalies may be associated, including deletions
17p conferring a more pejorative prognosis. IGH/BCL2 Fusion Transcript
Can also be detected by polymerase chain reaction (PCR) in biology
Molecular or by fluorescence in situ hybridization (FISH).
Initial balance Sheet
The examination and the clinical examination will first of all assess the
The general condition of the patient and the impact of the disease according to the ECOG/
Who.
The extension balance is based, in addition to the clinical examination, on the computed
(TDM) Cervico-thoraco-abdominal-pelvic with injection of
Contrasting product to identify ganglion areas affected and
Possible overnodal attacks. Pathological adenopathies should
Be measured in their two largest perpendicular diameters.
Ostéomédullaire biopsy can be used to search for medullary flooding
Common in this disease. In difficult cases, the immunophenotyping
The realization of a karyotype ± FISH and the molecular biology of the
Can help guide the diagnosis.
In the absence of a clinical appeal point, the systematic search for an infringing
Of the central nervous system is not necessary.
The place of positron emission tomography (PET) in the diagnosis is
Not formally established in the extension balance sheet. It appears, however, that
The majority of follicular lymphomas are greedy for fluorodeoxyglucose
(FDG), but no correlation between the fixation intensity and the grade of
tumor proliferation [3]. The initial evaluation by toe can
Evidence of invaded ganglion areas not detected by the scanner alone. This
Aspect is important to confirm a stage considered to be localized after
Clinical Examination and CT [4]. Pet can also put
Evidence of undetected Hypernodal attacks by the scanner: reaching
Ostéomédullaire focal length or splenic hit for example [5].
At the end of this assessment, the extension of the disease will be evaluated according to the
of Ann Arbor to distinguish localized (I-II) and scattered forms
(III-IV).