Follicular lymphoma natural history, complications and prognosis

Follicular lymphoma presents in the age group of 60-65 with systemic symptoms of fever, weight loss, anorexia, night sweats and other organ dependent symptoms based on the metastatic spread of the lymphoma. Complications arise from the systemic effects of the lymphoma and metastasis. The prognosis is evaluated from follicular lymphoma international prognostic index which divides patients into 3 groups.

• Follicular lymphoma presents in older age group people of age 60-65^[1][2][3][4].
• Patients may present with complaints of:
  • Unexplained fever
  • Weight loss
  • Painless and progressive adenopathy
  • Night sweats
  • Nerve lesions
  • Constant fatigue
  • Itchy skin
  • Reddened patches on the skin
  • Cough
  • Shortness of breath
• Organ-related symptoms develop depending on the metastatic spread of the lymphoma.
• Patients may have a history of:
  • Viral disease (HIV, HBV, HCV or EBV)
  • Autoimmune diseases
  • Immunocompromised state

• Skin reactions
• Bone marrow suppression
• Secondary cancers
• Gastric obstruction
• Urethral obstruction
• Renal failure
• Infertility
• Heart disease (Heart failure, valvular defects, pericarditis)
• Lung disease (Pleural effusion, lung mass)
• Mediastinal mass
• Immune system deficiency

• Follicular Lymphoma International Prognostic Index (FLIPI) is used for the evaluation of prognosis.^[5][6]

• It includes the following:

• • Age >60 years
  • Bone marrow involvement
  • Hemoglobin level <12.0 g/dl
  • Greatest diameter of the largest involved node >6 cm
  • Elevated serum β-2 microglobulin level
• The FLIPI divides patients into 3 groups:
  • Low (0-1 risk factor)
  • Intermediate (2 risk factors)
  • High (≥ 3 risk factors)
• The 10-year mortality of low group is 96%.
• The 10-year mortality of intermediate group is 71%.
• The 10-year mortality of high group is 37%.