Transformed follicular lymphoma in the rituximab era: A report from the S panish L ymphoma O ncology G roup

Follicular lymphoma (FL) is the second most common non‐Hodgkin lymphoma (NHL) subtype. The histological transformation (HT) of FL is an event considered frequent in the natural history of this tumor. We studied the transformation rates, predictive factors, and treatment characteristics that may impa...

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Veröffentlicht in:Hematological oncology 2019-04, Vol.37 (2), p.143-150
Hauptverfasser: Méndez, Miriam, Torrente, Maria, Sánchez‐Beato, Margarita, González‐Rincón, Julia, Royuela, Ana, Gómez‐Codina, José, de la Cruz‐Merino, Luis, Rueda, Antonio, Llanos, Marta, Quero, Cristina, Rodríguez‐Abreu, Delvys, Gumá, Josep, Monsalvo, Silvia, Sabin, Pilar, Provencio, Mariano
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container_end_page 150
container_issue 2
container_start_page 143
container_title Hematological oncology
container_volume 37
creator Méndez, Miriam
Torrente, Maria
Sánchez‐Beato, Margarita
González‐Rincón, Julia
Royuela, Ana
Gómez‐Codina, José
de la Cruz‐Merino, Luis
Rueda, Antonio
Llanos, Marta
Quero, Cristina
Rodríguez‐Abreu, Delvys
Gumá, Josep
Monsalvo, Silvia
Sabin, Pilar
Provencio, Mariano
description Follicular lymphoma (FL) is the second most common non‐Hodgkin lymphoma (NHL) subtype. The histological transformation (HT) of FL is an event considered frequent in the natural history of this tumor. We studied the transformation rates, predictive factors, and treatment characteristics that may impact in the survival of patients with FL and HT. A total of 1074 patients diagnosed with FL were prospectively enrolled from 1990 to 2016 in a Spanish registry. Sixty‐four HTs were recorded based on clinical criteria (55%) or histological confirmation (45%). The cumulative incidence rate of transformation at 5 years is 7.3%. The 5‐year overall survival (OS) without HT was 85% (95% confidence interval [CI], 70%‐90%) vs 66% (95% CI, 51%‐76%; P  = 0.0012) with HT. Factors associated with HT were elevated lactate dehydrogenase (LDH) (odds ratio [OR] 1.83), intermediate‐high Follicular lymphoma international prognostic index (FLIPI) (OR 2.16‐OR 3.21), B symptoms (OR 2.46), or Eastern Cooperative Oncology Group (ECOG) 1 (OR 2.35). Treatment options related to HT were “watch and wait” or no rituximab or anthracyclines initially. A 5‐year OS for patients treated with chemotherapy before HT was 55% (95% CI, 38%‐69%) versus 81% (95% CI, 53%‐93%; P  = 0.009) for those who had not received it. The HT rate has decreased after the introduction of rituximab, as has been previously described. The timing of this treatment had an impact on the survival of these patients.
doi_str_mv 10.1002/hon.2601
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The histological transformation (HT) of FL is an event considered frequent in the natural history of this tumor. We studied the transformation rates, predictive factors, and treatment characteristics that may impact in the survival of patients with FL and HT. A total of 1074 patients diagnosed with FL were prospectively enrolled from 1990 to 2016 in a Spanish registry. Sixty‐four HTs were recorded based on clinical criteria (55%) or histological confirmation (45%). The cumulative incidence rate of transformation at 5 years is 7.3%. The 5‐year overall survival (OS) without HT was 85% (95% confidence interval [CI], 70%‐90%) vs 66% (95% CI, 51%‐76%; P  = 0.0012) with HT. Factors associated with HT were elevated lactate dehydrogenase (LDH) (odds ratio [OR] 1.83), intermediate‐high Follicular lymphoma international prognostic index (FLIPI) (OR 2.16‐OR 3.21), B symptoms (OR 2.46), or Eastern Cooperative Oncology Group (ECOG) 1 (OR 2.35). Treatment options related to HT were “watch and wait” or no rituximab or anthracyclines initially. A 5‐year OS for patients treated with chemotherapy before HT was 55% (95% CI, 38%‐69%) versus 81% (95% CI, 53%‐93%; P  = 0.009) for those who had not received it. The HT rate has decreased after the introduction of rituximab, as has been previously described. 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title Transformed follicular lymphoma in the rituximab era: A report from the S panish L ymphoma O ncology G roup
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