Leukemic Presentation Is Predictive Indicator for Relapse for Patients with Follicular Lymphoma Treated with Rituximab Containing Initial Therapy.

Peripheral blood involvement (leukemic presentation) is considered as a part of bone marrow involvement and detected about 18% of bone marrow (BM) involvement of follicular lymphoma (FL). It is not known whether leukemic presentation is an adverse prognostic factor in rituximab era.

We retrospectively evaluate prognostic value of peripheral blood involvement in patients with follicular lymphoma received rituximab containing regimen as an initial therapy from October 2000 to January 2009. Leukemic presentation was defined by morphologic identification of an abnormal lymphoid population in the peripheral blood.

Total 129 patients were treated with rituximab containing initial therapy. Bone marrow involvement was detected in 39 /108 (36.1%) patients and leukemic presentation was identified in 8 / 39 (20.5%) of patients with BM involvement. Leukemic presentation shows significant poorer progression free survival than BM involvement without peripheral blood involvement. (2yr PFS 23.4% vs 73.3% p=0.015) Multivariate analysis conducted by Cox proportional hazard analysis including five variables of FLIPI revealed Hb <12g/dl (HR 2.769 95% CI: 1.111-6.902 p=0.029) and leukemic presentation (HR 5.127 95% CI: 1.898-13.853 p=0.001) were significant independent adverse prognostic factor for PFS.

Leukemic presentation is a significant adverse prognostic factor of FL in rituximab era. Prognostic value of leukemic presentation should be validated in further study.

No relevant conflicts of interest to declare.