REFRACTORY FOLLICULAR LYMPHOMA AND SHORT-TERM PATIENTS SURVIVAL IN THE ERA OF TARGETED TREATMENT. WHAT IS THE REASON?

Introduction. Prognostical indexes for follicular lymphoma (FLIPI, FLIPI-2 (Follicular Lymphoma International Prognostic Index)) not completely reflect the variability of disease and its prognosis. There appeared new data concerning the prognostic factors which can predict the disease behaviour more thoroughly. Search for new prognostic factors which can predict both immediate and late progression risk in follicular lymphoma is one of the most important tasks in oncohaematology. Objective. To compare the frequeneies of clinical and laboratory characteristics at diagnosis which negatively influenced the prognosis of follicular lymphoma was the purpose of this research. Matherials and methods._From 222 patients with follicular lymphoma we have identified 79 (36 %) aggressive course of the disease (1^st group): some patients died from follicular lymphoma progression during less than 3 years from diagnosis, in others - early relapses/progression took place in less than 24 months from start of treatment. We compared the frequences of clinical and laboratory characteristics at diagnosis which negatively influenced the prognosis of follicular lymphoma in patients of 1^st group with 143 patients of control (standard prognosis) group. 2 groups of follicular lymphoma patients were compared: 1^st group - 79 patients with unfavourable prognosis and 2^nd group - 143 patients with favourable prognosis. Results. Patients from the 1^st group compared to the 2^nd group had worse estimation according to ECOG, more frequent diminution of serum protein, more frequent Hb lower than 120 g/l, more frequent intoxication symptoms at diagnostics, more frequent involvement of more than 1 extranodal organ, more frequent involvement of spleen, worse treatment response, higher proportion of high risk according to FLIPI. New prognostic factors not included into existing prognostic models were identified. Negative prognostic factors for overall survival (OS) and progression-free survival (PFS) were diminution of serum protein level (OS p = 0,03; PFS p = 0,021), involvement of spleen (OS p = 0,000, PFS p = 0,002) and bad response (stabilization, progression) to 1^st line therapy (OS p = 0,000, PFS p = 0,000). Symptoms of intoxication negatively influenced OS (p = 0,000), but not PFS (p = 0,0127). Conclusion. Except of standard prognostic factors, several other facors can negatively influence the prognosis of follicular lymphoma: diminution of total serum protein, involvement of spleen, unsatisfactory response to 1^st line treatment (stabilization, progression), intoxication symptoms. These parameters are necessary to estimate and use for more thorough estimation of progression risk in follicular lymphoma.

фолликулярная лимфома, прогноз, общий белок сыворотки крови, follicular lymphoma, prognosis, total serum protein level

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