Prognostic factors in follicular lymphoma.
| Factor . | Effect on Outcome . | Mechanism . |
|---|---|---|
| * Dependent on treatment approach. Adriamycin-containing regimens suggest that grade 3 follicular lymphomas have improved survival parameters. | ||
| ** Initial studies indicated that marginal zone differentiation conferred an unfavorable outcome, but later studies refuted this finding. | ||
| # Initial studies suggest a favorable outcome associated with BCL6 translocations, but recent work suggests that these predispose to transformation. | ||
| ## Anti-tumor T cell response is associated with a favorable outcome in contrast to the macrophage signature that is associated with inferior survival. | ||
| ### Elevated cyclin B1 predicted favorable response to CHOP chemotherapy. | ||
| Increasing cytologic grade* | Unfavorable | Increased proliferation |
| Diffuse areas37 | Unfavorable | Early transformation |
| Marginal zone differentiation** | Equivocal | – |
| Intrafollicular proliferative rate | Unfavorable | Increased proliferation |
| Increased small vessel density19 | Favorable | ? |
| Bcl-2 expression | Unfavorable | Anti-apoptotic |
| Bcl-6 expression21 | Favorable | Germinal center phenotype |
| CD10 expression21 | Favorable | Germinal center phenotype |
| MDM2 expression38 | Unfavorable | Functional p53 loss |
| Bcl-XL expression17 | Unfavorable | Anti-apoptotic |
| Macrophage content11 | Unfavorable | Corrupt the microenvironment in favor of the tumor cells |
| Chromosomal gains18,20,39,40+7, +12q13–14, +18q | Unfavorable | Dominant oncogenes or dosage effect |
| Chromosomal losses18,41 del6q, −9p21, −17p13 | Unfavorable | Loss of tumor suppressor gene |
| BCL6 translocation42 # | Variable | Marker of genomic instability? |
| Host immune response## | Variable | Increased anti-tumor T cell response (IR-1) or promote trophic microenvironment for tumor cells (IR-2) |
| 81-gene predictor | Variable | Indolent versus aggressive behavior |
| Cyclin B122 ### | Favorable | Cell cycle progression |
| Factor . | Effect on Outcome . | Mechanism . |
|---|---|---|
| * Dependent on treatment approach. Adriamycin-containing regimens suggest that grade 3 follicular lymphomas have improved survival parameters. | ||
| ** Initial studies indicated that marginal zone differentiation conferred an unfavorable outcome, but later studies refuted this finding. | ||
| # Initial studies suggest a favorable outcome associated with BCL6 translocations, but recent work suggests that these predispose to transformation. | ||
| ## Anti-tumor T cell response is associated with a favorable outcome in contrast to the macrophage signature that is associated with inferior survival. | ||
| ### Elevated cyclin B1 predicted favorable response to CHOP chemotherapy. | ||
| Increasing cytologic grade* | Unfavorable | Increased proliferation |
| Diffuse areas37 | Unfavorable | Early transformation |
| Marginal zone differentiation** | Equivocal | – |
| Intrafollicular proliferative rate | Unfavorable | Increased proliferation |
| Increased small vessel density19 | Favorable | ? |
| Bcl-2 expression | Unfavorable | Anti-apoptotic |
| Bcl-6 expression21 | Favorable | Germinal center phenotype |
| CD10 expression21 | Favorable | Germinal center phenotype |
| MDM2 expression38 | Unfavorable | Functional p53 loss |
| Bcl-XL expression17 | Unfavorable | Anti-apoptotic |
| Macrophage content11 | Unfavorable | Corrupt the microenvironment in favor of the tumor cells |
| Chromosomal gains18,20,39,40+7, +12q13–14, +18q | Unfavorable | Dominant oncogenes or dosage effect |
| Chromosomal losses18,41 del6q, −9p21, −17p13 | Unfavorable | Loss of tumor suppressor gene |
| BCL6 translocation42 # | Variable | Marker of genomic instability? |
| Host immune response## | Variable | Increased anti-tumor T cell response (IR-1) or promote trophic microenvironment for tumor cells (IR-2) |
| 81-gene predictor | Variable | Indolent versus aggressive behavior |
| Cyclin B122 ### | Favorable | Cell cycle progression |