The grade of follicular lymphoma (FL) did not appear to affect patient outcomes, at least not conclusively. In the SEER database, researchers linked grades with disease-specific survival (DSS) and overall survival (OS) for 33,925 patients with nodal FL between 1992 and 2018. 

Compared to patients with FL grades 1-2, those with FL grade 3 showed poorer DSS and OS. Patients with FL grades 3 and grades 1-2 had 10-year DSSs of 68.6% and 71.4%, respectively, from 1992 to 2005; from 2006 to 2018, these rates increased to 77.7% and 82.6%, respectively. In the years 1992–2005, the 10-year OS estimates for grades 3 and 1-2 were 49.9% and 54.2%, respectively; in the years 2006–2018, they were 59.1% and 63.5%, respectively. 

After adjusting for stage and age, the hazard ratios for death from FL and death from any cause for patients with FL grade 3 during 1992-2005 were 1.09 (1.02–1.16) and 1.07 (1.02–1.12), respectively; and during 2006–2018, the hazard ratios for death from FL and death from any cause for patients with FL grade 3 were 1.34 (1.22–1.45) and 1.16 (1.10–1.23), respectively, compared to FL grades 1-2. The severity of FL has a significant role in disease biology.

Reference: onlinelibrary.wiley.com/doi/10.1111/bjh.18404