Page 16 - Haematologica Vol. 107 - September 2022

EDITORIAL
J.Y. Song
structure in FL3B may be related to the tumor micro- environment or an early snapshot of FL progressing to DLBCL. It is unclear whether cases of FL with devel- opment of DLBCL at a later time-point would also have many shared mutations like these composite cases. Clini- cal trials have recently started to include FL3B, as seen with the TRANSCEND NHL 001 trial, investigating anti- CD19 chimeric antigen receptor T cells. Another study, using selinexor plus chemotherapy for refractory aggres- sive B-cell lymphomas (NCT02471911), provides some promise for inclusion of this rare disease in future studies. The study by Koch and colleagues3 further underscores that FL3B may be a continuum of DLBCL with current evi- dence pointing towards grouping as an aggressive lym-
References
1. Barraclough A, Bishton M, Cheah CY, Villa D, Hawkes EA. The diagnostic and therapeutic challenges of grade 3B follicular lymphoma. Br J Haematol. 2021;195(1):15-24.
2. Ott G, Katzenberger T, Lohr A, et al. Cytomorphologic, immunohistochemical, and cytogenetic profiles of follicular lymphoma: 2 types of follicular lymphoma grade 3. Blood. 2002;99(10):3806-3812.
3. Koch C, Richter J, Hänel C, Hüttmann A, Dührsen U, Klapper W. Follicular lymphoma grade 3B and diffuse large B-cell lymphoma present a histopathological and molecular continuum lacking features of progression/transformation. Haematologica. 2022;107(9):2144-2153.
phoma. Cases with only FL3B may be a result of limited sampling with DLBCL being present in less surgically ac- cessible sites. Mutational profiling has yet to provide a mechanism of disease progression and more cases of paired FL and DLBCL are required to address these issues. Although there are challenges in studying FL3B due to the rarity of the disease, inclusion of FL3B in prospective trials, with steps to study the combination with genomic correlatives, will help to clarify how to define the disease better. This, in turn, will help to aid the process towards selecting appropriate treatment.
Disclosures
No conflicts of interest to disclose.
4. Swerdlow S, Campo E, Harris NL, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: International Agency for Research on Cancer, 2017.
5. Bouska A, Zhang W, Gong Q, et al. Combined copy number and mutation analysis identifies oncogenic pathways associated with transformation of follicular lymphoma. Leukemia. 2017;31(1):83-91.
6. Dührsen U, Müller S, Hertenstein B, et al. Positron emission tomography–guided therapy of aggressive non-Hodgkin lymphomas (PETAL): a multicenter, randomized phase III trial. J Clin Oncol. 2018;36(20):2024-2034.
Haematologica | 107 September 2022
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