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Ann Hematol. 2018 Jan;97(1):17-29. doi: 10.1007/s00277-017-3151-2. Epub 2017 Oct 18.

Transformed follicular lymphoma.

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Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, SP, Brazil.
University of Modena and Reggio Emilia, Modena, Italy.
University of Modena and Reggio Emilia, Modena, Italy.
Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Arcispedale Santa Maria Nuova IRCCS, viale Risorgimento n°80 42123, Reggio Emilia, Italy.


Follicular Lymphoma (FL) is the second most common type of non-Hodgkin lymphoma and is considered to be the prototype of indolent lymphomas. Histologic transformation into an aggressive lymphoma, which is expected to occur at a rate of 2 to 3% each year, is associated with rapid progression, treatment resistance, and poor prognosis. Recent modifications to the physiopathologic mechanism of transformed follicular lymphoma (t-FL) have been proposed, including genetic and epigenetic mechanisms as well as a role for the microenvironment. Although t-FL is considered a devastating complication, as it is associated with treatment-refractory disease and a dismal outcome, recent data in the rituximab era have suggested that not only is the prognosis less severe than reported in the previous literature but the risk of transformation is also lower. Thus, this study aimed to review the most recent research on t-FL in an attempt to better understand the clinical meaning of transformation from FL to diffuse large B cell lymphoma (DLBCL) and the impact of current treatment strategies on the curability of this intriguing subentity of lymphoma.


Cell transformation, neoplastic; Diffuse; Diffuse large cell lymphoma; Epigenetic; Genetic transformation; Lymphoma; Lymphoma, follicular; Lymphoma, large B cell; Lymphoma, non-Hodgkin; Prognosis, cell neoplastic transformation

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