Follicular lymphoma natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Prognosis is generally poor and the 5 year survival rate of patients with follicular lymphoma is approximately 72-77%.
Follicular lymphoma presents in the age group of 60-65 with systemic symptoms of fever, weight loss, anorexia, night sweats and other organ dependent symptoms based on the metastatic spread of the lymphoma. Complications arise from the systemic effects of the lympoma and metastasis. The prognosis is evaluated from follicular lymphoma international prognostic index which divides patients into 3 groups.
 
== Natural history ==
* Follicular lymphoma presents in older age group people of age 60-65.
* Patients may present with complaints of:
** Unexplained fever
** Weight loss
** Painless and progressive adenopathy
** Night sweats
** Gastric symptoms
** Urinary symptoms
** Nerve lesions
** Constant [[Fatigue (physical)|fatigue]]
** [[Pruritis|Itchy skin]]
** Reddened patches on the skin
** [[Cough]]
** [[Shortness of breath]]
* Organ related symptoms develop depending on the metastatic spread of the lymphoma.
* Patients may have a history of:
** Viral disease (HIV, HBV, HCV or EBV)
** Autoimmune diseases
** Immunocompromised state
 
== Complications ==
* Skin reactions
* Bone marrow suppresion
* Second cancers
* Gasrric obstruction
* Urethral obstruction
* Renal failure
* Infertility
* Heart problems (Heart failure, vavular defects, pericarditis)
* Lung problems (Pleural effusion, lung mass)
* Mediastinal mass
* Immune system deficiency
 
==Prognosis==
==Prognosis==
*Follicular lymphoma is regarded as incurable (although allogenic [[stem cell transplantation]] may be curative, the mortality from the procedure is too high to be a first line option). The [[median]] survival is around 10 years, but the range is wide, from less than one year, to more than 20 years. Some patients may never need treatment. The overall survival rate at 5 years is 72-77%.<ref>{{EMedicine|article|203268|Lymphoma, Follicular}}</ref>
* Follicular Lymphoma International Prognostic Index (FLIPI) is used for the evaluation of prognosis.
*The following factors are associated with poor prognosis:<ref name="seer">National Cancer Institute. Surveillance, Epidemiology, and End Results Program 2015. http://seer.cancer.gov</ref>.
 
:*Grade 3 histopathologic grading
* It includes the following:
:*Presence of cytogenic abnormalities of ''BCL-6'' gene
 
** age >60 years
** bone marrow involvement
** hemoglobin level <12.0 g/dl
** greatest diameter of the largest involved node >6 cm
** elevated serum β-2 microglobulin level
* The FLIPI divides pateints into 3 groups:
** Low (0-1 risk factor)
** Intermediate (2 risk factors)
** High (≥ 3 risk factors)
* The 10 year mortality of low group is 96%.
* The 10 year mortality of intermediate group is 71%.
* The 10 year mortality of high group is 37%.


==References==
==References==

Revision as of 18:38, 24 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]

Overview

Follicular lymphoma presents in the age group of 60-65 with systemic symptoms of fever, weight loss, anorexia, night sweats and other organ dependent symptoms based on the metastatic spread of the lymphoma. Complications arise from the systemic effects of the lympoma and metastasis. The prognosis is evaluated from follicular lymphoma international prognostic index which divides patients into 3 groups.

Natural history

  • Follicular lymphoma presents in older age group people of age 60-65.
  • Patients may present with complaints of:
    • Unexplained fever
    • Weight loss
    • Painless and progressive adenopathy
    • Night sweats
    • Gastric symptoms
    • Urinary symptoms
    • Nerve lesions
    • Constant fatigue
    • Itchy skin
    • Reddened patches on the skin
    • Cough
    • Shortness of breath
  • Organ related symptoms develop depending on the metastatic spread of the lymphoma.
  • Patients may have a history of:
    • Viral disease (HIV, HBV, HCV or EBV)
    • Autoimmune diseases
    • Immunocompromised state

Complications

  • Skin reactions
  • Bone marrow suppresion
  • Second cancers
  • Gasrric obstruction
  • Urethral obstruction
  • Renal failure
  • Infertility
  • Heart problems (Heart failure, vavular defects, pericarditis)
  • Lung problems (Pleural effusion, lung mass)
  • Mediastinal mass
  • Immune system deficiency

Prognosis

  • Follicular Lymphoma International Prognostic Index (FLIPI) is used for the evaluation of prognosis.
  • It includes the following:
    • age >60 years
    • bone marrow involvement
    • hemoglobin level <12.0 g/dl
    • greatest diameter of the largest involved node >6 cm
    • elevated serum β-2 microglobulin level
  • The FLIPI divides pateints into 3 groups:
    • Low (0-1 risk factor)
    • Intermediate (2 risk factors)
    • High (≥ 3 risk factors)
  • The 10 year mortality of low group is 96%.
  • The 10 year mortality of intermediate group is 71%.
  • The 10 year mortality of high group is 37%.

References