Does a diffuse growth pattern predict for survival in patients with low-grade follicular lymphoma?

Low-grade follicular lymphoma (LGFL) is known to have a good prognosis. However, the clinical relevance of the presence and extent of diffuse growth areas within LGFL is not clear. Therefore, we studied 457 patients with nodal LGFL seen over a 20-year period (1982-2002). Relevant clinical and survival data were obtained and the pathology specimens were subclassified into predominantly follicular LGFL (>or=80% follicular areas), significantly follicular LGFL (30-70% follicular areas), significantly diffuse LGFL (<30% follicular areas) and pure diffuse follicle centre lymphoma (DFCL). The majority of the patients were treated with anthracycline-based regimens. Patients with DFCL were slightly older (median age, 67 years), more likely to have bulky disease (>5 cm), and often had suboptimal biopsies. However, no association was observed between the extent of diffuse areas and survival across the four subgroups. We conclude that the subclassification of LGFL based on the extent of diffuse areas does not have clinical relevance.