The incidence of biopsy-proven transformation in follicular lymphoma in the rituximab era. A retrospective analysis from the Czech Lymphoma Study Group (CLSG) database

Abstract

The aim of this study is to assess the incidence, risk factors, and outcome of biopsy-proven transformation in follicular lymphoma (FL) patients in the rituximab era. Transformation was analyzed in 1233 patients with initially diagnosed FL grades 1-3A, identified between 2002 and 2012 in the prospectively maintained Czech Lymphoma Study Group database. Only patients with histologically proven transformation (HT) were included. HT occurred in 58 cases at a median of 3.0 years from the initial FL diagnosis; the HT rate was 4% at 5 years. Transformation occurred most frequently at the first relapse (84% patients). Median OS from the HT was 2.5 years (95% CI 0.4-4.6) and 6-year OS with HT was shorter compared to all FLs (60 vs. 83.9%; 95% CI). A bulky tumor (≥ 10 cm), increased lactate dehydrogenase, age ≥ 60 years, and International Prognostic Index (intermediate/high risk), but not Follicular Lymphoma International Prognostic Index, were associated with transformation (p < 0.05). In the first line, 70% of patients received rituximab (including 36% rituximab maintenance), 57% CHOP-like regimens, and 2.6% of patients were treated with fludarabine-based therapy, whereas 11% of patients were watched only. The patients treated with R-CHOP in the first line (n = 591) showed the transformation rate at 5 years of 4.23% (95% CI 2.52-5.93); subsequent rituximab maintenance (n = 276) vs. observation (n = 153) was associated with a lower transformation rate (p.033; HR 3.29; CI 1.10-9.82). The transformation rate seems to be lower than in previous series, which may be influenced by broad use of rituximab, but prognosis of HT developed during therapy continues to be poor.

Low number of intrafollicular T cells may predict favourable response to rituximab-based immuno-chemotherapy in advanced follicular lymphoma: a secondary analysis of a randomized clinical trial

“…Transformation into high-grade diffuse large B-cell lymphoma is observed in approx. 4% after 5 years in rituximab-treated patients, which seems lower than in the pre-rituximab era (Janikova et al 2018).…”

Is percutaneous computed tomography-guided biopsy sufficient to establish indolent lymphoma transformation?

“…fever, night sweats, and weight loss. Also, some laboratory findings are related to transformation – elevation of the serum level of lactate dehydrogenase (LDH), anemia, and thrombocytopenia [5, 17]. Some risk factors have also been defined for transformation development: they can only slightly differ among particular histological types.…”

“…Some risk factors have also been defined for transformation development: they can only slightly differ among particular histological types. Eastern Cooperative Oncology Group (ECOG) performance status > 1, involvement of more than one extranodal structure, histological grade 3 or 4, lack of complete remission following initial treatment, and decreased serum level of albumin or increased serum level of β 2 -microglobulin are some of the reported risk factors [5, 22]. Several studies include cases with transformation diagnosed following clinical and laboratory criteria [9].…”

“…The patient survival rate of indolent lymphomas exceeds 10 years [4, 5]. The composition of the indolent lymphoma tumorous mass becomes, in time, more and more heterogeneous.…”

Predictive Role of Circulating Immune Cell Subtypes Early after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Acute Leukemia

“…Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important therapeutic modality for malignancies of hematopoietic origin, some metastatic solid tumors, and a variety of nonmalignant diseases. The most common indications for allo-HSCT are acute leukemias including acute myeloid leukemia (AML) and adult acute lymphoblastic leukemia (ALL) who respond to induction systemic chemotherapy (1). The success of allo-HSCT depends, in large part, on the robust recovery of the lymphoid and myeloid hematopoietic system.…”