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<p>This study aimed to compare the clinical characteristics and survival outcomes between patients with grade 3B follicular lymphoma (G3BFL) and those with diffuse large B-cell lymphoma transformed from follicular lymphoma (t-DLBCL) using a real-world cohort. A retrospective analysis was conducted on 103 patients (59 G3BFL, 44 t-DLBCL) diagnosed between 2012 and 2022. Propensity score matching (PSM) was employed to balance baseline characteristics. Survival outcomes, prognostic factors, and the performance of FLIPI-1 and FLIPI-2 were evaluated using Kaplan-Meier analysis and Cox regression models. After 1:1 PSM (30 matched pairs), no significant differences were observed in progression-free survival (PFS) or overall survival (OS) between G3BFL and t-DLBCL groups. In the overall cohort, Ki-67 was significantly higher in G3BFL (70% vs. 50%, <i>P</i> &lt; 0.001). In multivariable models for PFS, age ≥ 60 years, bone marrow involvement, and advanced stage were independent risk factors for inferior PFS; in the OS model, progression of disease within 24 months (POD24) and extranodal involvement predicted worse OS. Maintenance therapy (administered to 50.5% of patients) showed no OS benefit. FLIPI-2 demonstrated superior discriminative ability for 3-year OS compared to FLIPI-1 (<i>P</i> &lt; 0.001 vs. <i>P</i> = 0.040). This PSM-adjusted real-world analysis indicates similar survival between G3BFL and t-DLBCL, challenging the traditional perception of t-DLBCL as invariably more aggressive. FLIPI-2 provides effective risk stratification, whereas maintenance therapy did not improve OS. These findings underscore the need for biology-driven treatment strategies and warrant validation in larger prospective studies integrating molecular profiling.</p>

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Therapeutic Outcomes in Aggressive B‑Cell Lymphomas: A Propensity‑Matched Comparison of Grade 3B Follicular Lymphoma and Transformed DLBCL from a Real‑World Chinese Cohort

  • 期刊论文

  • 发表日期：

    2026年5月13日

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  • Chuchu Chen,
  • Yunfei Lv,
  • Xiang Zhang,
  • Xingnong Ye,
  • Juying Wei,
  • Jinghan Wang,
  • Parnia Ghanad,
  • Maryam Maleki Goli,
  • Wenjuan Yu

摘要

This study aimed to compare the clinical characteristics and survival outcomes between patients with grade 3B follicular lymphoma (G3BFL) and those with diffuse large B-cell lymphoma transformed from follicular lymphoma (t-DLBCL) using a real-world cohort. A retrospective analysis was conducted on 103 patients (59 G3BFL, 44 t-DLBCL) diagnosed between 2012 and 2022. Propensity score matching (PSM) was employed to balance baseline characteristics. Survival outcomes, prognostic factors, and the performance of FLIPI-1 and FLIPI-2 were evaluated using Kaplan-Meier analysis and Cox regression models. After 1:1 PSM (30 matched pairs), no significant differences were observed in progression-free survival (PFS) or overall survival (OS) between G3BFL and t-DLBCL groups. In the overall cohort, Ki-67 was significantly higher in G3BFL (70% vs. 50%, P < 0.001). In multivariable models for PFS, age ≥ 60 years, bone marrow involvement, and advanced stage were independent risk factors for inferior PFS; in the OS model, progression of disease within 24 months (POD24) and extranodal involvement predicted worse OS. Maintenance therapy (administered to 50.5% of patients) showed no OS benefit. FLIPI-2 demonstrated superior discriminative ability for 3-year OS compared to FLIPI-1 (P < 0.001 vs. P = 0.040). This PSM-adjusted real-world analysis indicates similar survival between G3BFL and t-DLBCL, challenging the traditional perception of t-DLBCL as invariably more aggressive. FLIPI-2 provides effective risk stratification, whereas maintenance therapy did not improve OS. These findings underscore the need for biology-driven treatment strategies and warrant validation in larger prospective studies integrating molecular profiling.