INTOXICATION SYMPTOMS IN FOLLICULAR LYMPHMA: PROBABLE PATHOGENESIS AND CLINICAL SIGNIFICANCE

Abstract

Introduction. About 25 % of patients at diagnosis of follicular lymphoma have intoxication symptoms, which are probably induced by endogeneous cytokines. Production of several cytokines may be followed by temperature, lypogenesis disturbances, anorexia, body weight loss and so on. The pathogenesis of intoxication symptoms and its clinical significance are not completely understood in follicular lymphoma. Objective - to investigate the clinical and prognostic significance of presence of intoxication symptoms at the opening stages of follicular lymphomas. Matherials and methods. We’ve characterized a group of 74 follicular lymphoma patients, which had at time of diagnosis B-symptoms. Comparison group included 207 patients without intoxication symptoms. Results. In patients with B-symptoms we noted higher estimation according to ECOG scale, more fequent of haemoglobin diminution less than 120 g/l. It was more frequently noted elevation of LDH levels and diminution of serum total protein concentration. Presense of intoxication symptoms usually indicated the more turmor burden in patients: in 90,5 % advanced disease stages, in 75,7 % involvement of more than 4 nodal zones, in 81,1 % peripheral lymph nodes above diaphragm were involved, in 35,1 % mediastinal lymph nodes, and in 74,3 % of patients retroperitoneal lymph nodes were involved. More frequently in patients with intoxication symptoms more than one extranodal zone was ivolved, especially spleen and hepar. According to FLIPI 64,2 % of follicular lymphoma patients with B-symptoms were of high risk group, and they had worse quality of treatment response: in 25 % of cases progression during or soon after treatment was noted. Intoxication symptoms negatively influensed on overall survival, but not on the duration of treatment response. Conclusion. Intoxication symptoms significantly affects overall survival and survival without progression in follicular lymphoma patients. Key words: follicular lymphoma, intoxication symptom