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Background. Grade 3 follicular lymphoma (FL) is a heterogenetic group of tumors. The selections of patients with similar characteristics of the tumor process is important for classifi cation 3 grade forms of FL and risk stratifi cation, as well as for the development of new therapeutic approaches. Diff erent morphological, immunohistochemical and cytogenetical characteristics of the tumor result in diff erent clinical forms of the disease. Aim. To describe the clinical, morphological, immunohistochemical and cytogenetical characteristics of grade 3 FL and evaluate their prognostic value for R-CHOP-21 chemotherapy. Materials & Methods. We performed retrospective and prospective analysis of morphological, immunohistochemical and genetical characteristics of 93 primary patients with grade 3 FL (21–78 years, median 53 years, women to men — 1:1.4) admitted to National Medical Hematology Research Center from years 2001 to 2016. Morphological and immunohistochemical assessment of the aff ected lymph nodes and bone marrow biopsy material was performed. Data obtained from the standard cytogenetic and FISH assessment were compared to identify the BCL2 rearrangement. Results. We proposed an algorithm for diff erential diagnosis of the 2 types of grade 3 FL: de novo FL (n = 22) and transformed FL (n  =  21). De novo grade 3 FL had the immunophenotype of CD10– in 19 (86  %) cases, MUM1++ (monomorphically) in 19 (90 %), and BCL-2 in 5 (22 %). It was characterized by the absence of the BCL2 rearrangement (n = 22, 100 %) and bone marrow involvement (n = 14, 67 %) and/or bone marrow involvement (n = 7, 100 %). Third grade FL transformed from grades 1 or 2 had was CD10+ (n = 19, 90  %), MUM1+ (heterogeneously, n  =  16, 76  %) or MUM1– (n = 4, 19 %), BCL-2+ (n = 20, 95 %) and had BCL2 rearrangement (n = 19, 90 %). Small cell bone marrow involvement was observed in 71 % of cases, whereas large cell involvement was seen predominantly in de novo FL (p = 0.06). The analysis showed that 5-year relapse-free survival in patients with 454 Л.В. Пластинина и др. КЛИНИЧЕСКАЯ ОНКОГЕМАТОЛОГИЯ имеет экспрессию в опухолевых клетках CD10+ (n  =  19; 90 %), MUM1+ (гетерогенно, n =  16; 76 %) или отсутствие экспрессии MUM1 (n = 4; 19 %), BCL-2+ (n = 20; 95 %) и реаранжировку BCL2 (n = 19; 90 %). При трансформированной ФЛ 3-го типа в 71 % случаев встречается мелкоклеточное лимфоидное поражение костного мозга, при ФЛ 3-го типа de novo — крупноклеточное (p = 0,06). Безрецидивная 5-летняя выживаемость больных ФЛ 3-го типа de novo на фоне терапии R-CHOP-21 составляет 87 vs 16 % при трансформированной ФЛ 3-го типа (p = 0,06) с медианой наблюдения 41 мес. Заключение. В группе ФЛ 3-го цитологического типа выделено два варианта, характеризующиеся различными морфологическими, иммуногистохимическими и цитогенетическими признаками и обладающие различной чувствительностью к иммунохимиотерапии: 1) вариант, развившийся de novo; 2) вариант, развившийся в результате трансформации ФЛ 1–2-го типа. Ключевые слова: фолликулярная лимфома 3-го цитологического типа, ФЛ de novo, трансформированная ФЛ, гистологическая трансформация, экспрессия MUM1. Получено: 14 апреля 2017 г. Принято в печать: 23 июля 2017 г. Для переписки: Любовь Васильевна Пластинина, Новый Зыковский пр-д, д. 4, Москва, Российская Федерация, 125167; тел.: 8(495)612-23-61; e-mail: dr.plastinina@yandex.ru Для цитирования: Пластинина Л.В., Ковригина А.М., Обухова Т.Н. и др. Фолликулярная лимфома 3-го цитологического типа: de novo и трансформированный варианты заболевания (собственные данные). Клиническая онкогематология. 2017;10(4):453–63. DOI: 10.21320/2500-2139-2017-10-4-453-463 grade 3 de novo FL after R-CHOP-21 therapy was 87 % compared to 16 % with transformed FL (p = 0.06) for the median 41 months of follow up. Conclusion. We described the morphological, immunohistochemical and cytogenetical characteristics of grade 3 de novo FL and grade 3 FL, transformed from grades 1 or 2. The described variants show diff erent sensitivity to immunochemotherapy.

The Comparison of De Novo Grade 3 Follicular Lymphoma and Transformed Grade 3 Follicular Lymphoma: Own Data