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Hematol Oncol. 2019 Apr;37(2):143-150. doi: 10.1002/hon.2601. Epub 2019 Apr 4.

Transformed follicular lymphoma in the rituximab era: A report from the Spanish Lymphoma Oncology Group.

Author information

1
Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
2
Medical Oncology Department, Hospital Universitario La Fe de Valencia, Valencia, Spain.
3
Medical Oncology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain.
4
Medical Oncology Department, Hospital Universitario Costa del Sol, Marbella, Spain.
5
Medical Oncology Department, Hospital Universitario de Canarias, Canary Islands, Spain.
6
Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
7
Medical Oncology Department, Complejo Hospitalario Universitario Insular de Canarias, Canary Islands, Spain.
8
Medical Oncology Department, Hospital Universitari Sant Joan de Reus, Tarragona, Spain.
9
Medical Oncology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
10
Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Abstract

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.

KEYWORDS:

follicular lymphoma; histological transformation; risk factors; rituximab

PMID:
30840776
DOI:
10.1002/hon.2601
[Indexed for MEDLINE]

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