Malignant lymphomas of follicular center cell origin in man.III. Prognostic Features

Prognostic features were evaluated in 92 patients with follicular center cell (FCC) lymphomas. Cleaved-cell lymphomas (N = 73) were associated with significantly better survival than transformed cell lymphomas, 58 months vs. 6 months (p < .001). Among the cleaved-cell group neither age, sex, heavy or light chain surface immunoglobulin, nor bone marrow involvement was a statistically significant prognostic indicator of survival. With stratification by cell of origin, survival in patients with cleaved-cell lymphoma having a nodular histologic pattern was statistically equivalent to survival in patients having a diffuse histologic pattern (p = .22). FCC lymphomas of small cleaved cells had a better median survival than lymphomas of large cleaved cells (61 months vs. 33 months) but this only approached statistical significance (p = .08). Patients with symptoms had a median survival of 40 months as compared to 72 months in patients asymptomatic at presentation (p = .07). Involvement of lungs, pleura, or gastrointestinal tract, or extensive hepatic involvement was associated with a median survival of 16 months as compared to 63 months in patients in whom these features were absent (p < .001). Classification of lymphomas with respect to imune origin has clinical significance as it allows the identification of patients with B-cell neoplasms who may have a clinical course similar to that usually associated with nodular lymphomas despite having a diffuse histologic pattern. Although in cleaved FCC lymphomas marrow involvement apparently has no prognostic value, involvement of other stage IV sites has grave prognostic implications; therefore, use of the term stage IV without specification of involved site may be of limited meaning in patients with these lymphomas.