Clinical features and prognosis analysis of patients with follicular lymphoma: a real-world study in China

Follicular lymphoma (FL) is a common indolent B-cell lymphoma with heterogeneous clinical behavior. Prognostic data from Chinese real-world populations remain Limited. We retrospectively analyzed 118 patients with newly diagnosed FL treated at our center from January 2022 to December 2024. Clinical features, laboratory indicators, immune markers, and treatment responses were evaluated. Survival outcomes were analyzed using Kaplan–Meier and Cox regression methods. The follow-up ended on January 31, 2025, with a median follow-up duration of 11.2 months (range, 1.1–36.0 months). The 2-year overall survival (OS) and progression-free survival (PFS) rates were 90.1% and 69.7%, respectively. The overall complete response (CR) rate was 60.2%. In univariate analysis, several factors including pathological grade 3B/composite histology, B symptoms, low NK cell percentage (< 8%), low CD4 ⁺ T cell levels (< 30%), CD5 positivity, CD10 negativity, and MUM1 positivity were significantly associated with poor OS and/or PFS. Multivariate Cox regression revealed that pathological grade 3B/composite histology was an independent risk factor for PFS (HR 2.933, P  = 0.035), while NK cell percentage < 8% independently predicted worse OS (HR 0.067, P  = 0.005). This study validates the prognostic significance of pathological grade and NK cell levels in a Chinese real-world FL population. Peripheral blood NK cell percentage may serve as a clinically useful biomarker for host immune status and prognosis. The findings support further investigation into immune-based prognostic markers and therapeutic strategies in FL.