{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T14:16:53Z","timestamp":1781533013150,"version":"3.54.5"},"reference-count":46,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,2,3]],"date-time":"2017-02-03T00:00:00Z","timestamp":1486080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100002809","name":"Generalitat de Catalunya","doi-asserted-by":"publisher","award":["SGR225"],"award-info":[{"award-number":["SGR225"]}],"id":[{"id":"10.13039\/501100002809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hematological Oncology"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Follicular lymphoma is characterized by a good response to immunochemotherapy (ICT). However, a small percentage of patients responds poorly to treatment and seems to have a worse outcome. This study attempted to identify the predictive factors and outcome of refractoriness to first\u2010line ICT. All patients diagnosed with stage II to IV follicular lymphoma between 2002 and 2014 and treated with first\u2010line ICT in 4 Spanish institutions were analyzed. Those with no response or progression or relapse within 6\u00a0months of first\u2010line response assessment were considered ICT refractory. Three hundred forty\u2010three patients were included (median age 58\u00a0years, 48% male), of whom 53 (15%) were ICT refractory. On multivariate analysis, high\u2010risk follicular lymphoma international prognostic index (FLIPI) score, B symptoms, and elevated \u03b22\u2010microglobulin were correlated with refractoriness, and refractoriness, high\u2010risk FLIPI score, and \u03b22\u2010microglobulin were correlated with overall survival (OS). Compared with ICT\u2010sensitive, ICT\u2010refractory patients had a higher incidence of histological transformation (5\u2010year cumulative incidence 25% [14%\u201039%] vs. 6% [3%\u201010%], <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), a higher rate of refractoriness to second\u2010line therapy (16\/33 [48%] vs. 13\/57 [23%], <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01), and a lower OS (5\u2010year OS probability 38% [95% CI 23%\u201053%] vs. 87% [82%\u201092%%], <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). In conclusion, refractoriness to ICT was seen in 15% of patients and was predicted by high\u2010FLIPI scores, B symptoms, and elevated serum \u03b22\u2010micrglobulin. Immunochemotherapy\u2010refractory patients had a worse prognosis than ICT\u2010sensitive patients, and current treatment options for this subgroup are not satisfactory.<\/jats:p>","DOI":"10.1002\/hon.2378","type":"journal-article","created":{"date-parts":[[2017,2,3]],"date-time":"2017-02-03T10:33:45Z","timestamp":1486118025000},"page":"520-527","source":"Crossref","is-referenced-by-count":18,"title":["Refractoriness to immunochemotherapy in follicular lymphoma: Predictive factors and outcome"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0587-591X","authenticated-orcid":false,"given":"Marc","family":"Sorigue","sequence":"first","affiliation":[{"name":"Department of Hematology. ICO\u2010Badalona, Hospital Germans Trias i Pujol, Institut de Recerce Josep Carreras Universitat Aut\u00f2noma de Barcelona  Badalona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Mercadal","sequence":"additional","affiliation":[{"name":"Department of Hematology. ICO\u2010Duran y Reynals Hospitalet de Llobregat  Bacelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Alonso","sequence":"additional","affiliation":[{"name":"Department of Hematology Hospital Universitario de Salamanca  Salamanca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Fern\u00e1ndez\u2010\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Department of Hematology Hospital de Cabue\u00f1es  Gij\u00f3n Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Clinical Hematology. ICO\u2010Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras Universitat Aut\u00f2noma de Barcelona  Badalona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Clinical Hematology. ICO\u2010Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras Universitat Aut\u00f2noma de Barcelona  Badalona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Pomares","sequence":"additional","affiliation":[{"name":"Department of Hematology. ICO\u2010Duran y Reynals Hospitalet de Llobregat  Bacelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Alcoceba","sequence":"additional","affiliation":[{"name":"Department of Hematology Hospital Universitario de Salamanca  Salamanca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Gonz\u00e1lez\u2010Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Hematology Hospital de Cabue\u00f1es  Gij\u00f3n Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Motll\u00f3","sequence":"additional","affiliation":[{"name":"Department of Clinical Hematology. ICO\u2010Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras Universitat Aut\u00f2noma de Barcelona  Badalona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Gonz\u00e1lez\u2010Barca","sequence":"additional","affiliation":[{"name":"Department of Hematology. ICO\u2010Duran y Reynals Hospitalet de Llobregat  Bacelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Hematology Hospital Universitario de Salamanca  Salamanca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Sureda","sequence":"additional","affiliation":[{"name":"Department of Hematology. ICO\u2010Duran y Reynals Hospitalet de Llobregat  Bacelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Caballero","sequence":"additional","affiliation":[{"name":"Department of Hematology Hospital Universitario de Salamanca  Salamanca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep\u2010Mar\u00eda","family":"Ribera","sequence":"additional","affiliation":[{"name":"Department of Clinical Hematology. ICO\u2010Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras Universitat Aut\u00f2noma de Barcelona  Badalona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan\u2010Manuel","family":"Sancho","sequence":"additional","affiliation":[{"name":"Department of Clinical Hematology. 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