Transformed non‐Hodgkin lymphoma in the rituximab era: analysis of the <scp>NCCN</scp> outcomes database

Ban‐Hoefen, Makiko; Vanderplas, Ann; Crosby-Thompson, Allison; Abel, Gregory A.; Czuczman, Myron S.; Li, Gordon; Kaminski, Mark; Kelly, Jennifer L.; Millenson, Michael; Nademanee, Auayporn; Rodriguez, Maria Alma; Zelenetz, Andrew D.; Niland, Joyce C.; LaCasce, Ann S.; Friedberg, Jonathan W.

doi:10.1111/bjh.12570

Cited by 65 publications

(74 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this multi-institutional, prospective, observational study, the 5-and 8-year transformation rates were 12.8% and 19.4%, respectively, which is consistent with the incidence of 9% to 17% at 5 years and 15% to 30% at 10 years observed in retrospective studies. [3][4][5][6][7]9 The observation in other series, 10,15 as well as our own, that transformation rates are similar in the modern era suggests that †Patients with at least a response of stable disease to an initial rituximab-based regimen who were followed at least 215 days after the end of induction without experiencing progressive disease or starting a subsequent therapy within this time frame were included in analysis. chemoimmunotherapy is not impacting the incidence of transformation.…”

Section: Discussionmentioning

confidence: 82%

“…The median posttransformation OS of nearly 5 years in the NLCS is similar to recent series of tFL. 10,15 Compared with the dismal prognosis described in historical reports, these newer studies raise the question as to whether this change reflects advancements in current treatments. The disparity seen in the relatively short median posttransformation PFS of ;1 year compared with the longer OS additionally suggests improvements in treatment.…”

Section: Discussionmentioning

confidence: 99%

“…An analysis of the National Comprehensive Cancer Network (NCCN) non-Hodgkin lymphoma outcomes database demonstrated 2-and 5-year OS rates of 68% and 49%, respectively, among 118 patients with tFL diagnosed between 2000 and 2011. 10 Treatment of the indolent lymphoma prior to HT included regimens containing rituximab (70%) and/or anthracyclines (51%). A smaller subset was observed without treatment (19%).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes of transformed follicular lymphoma in the modern era: a report from the National LymphoCare Study (NLCS)

Wagner‐Johnston

Link

Byrtek³

et al. 2015

Blood

Self Cite

181

170

View full text Add to dashboard Cite

Key Points• The median posttransformation survival of 5 years suggests improved outcomes for transformed FL in the modern era.• Five-year progression-free and overall survival (66% and 88%) are favorable for patients with evidence of transformation at diagnosis.We assessed the incidence, prognostic features, and outcomes associated with transformation of follicular lymphoma (FL) among 2652 evaluable patients prospectively enrolled in the National LymphoCare Study. At a median follow-up of 6. , 83-86). The median overall survival posttransformation was 5 years. Forty-seven patients with evidence of transformation at the time of diagnosis shared similar prognostic factors and survival rates to those without transformation. Improved outcomes for transformation in the modern era are suggested by this observational study. This trial is registered at www.clinicaltrials.gov as #NCT00097565. (Blood. 2015;126(7):851-857)

show abstract

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of transformed follicular lymphoma in the modern era: a report from the National LymphoCare Study (NLCS)

Wagner‐Johnston

Link

Byrtek³

et al. 2015

Blood

Self Cite

181

170

View full text Add to dashboard Cite

show abstract

“…Transformation into DLBCL has been reported at a rate of 3% per year in patients with follicular lymphoma [22], but aggressive transformation may occur in every subtype of indolent NHL [23], including WM [24,25]. Patients who develop histologic transformation experience poor survival [22], which may have improved with the addition of rituximab to chemotherapy and highdose chemotherapy followed by autologous stem cell rescue [23].…”

Section: Discussionmentioning

confidence: 99%

Survival outcomes of secondary cancers in patients with waldenström macroglobulinemia: An analysis of the SEER database

et al. 2015

View full text Add to dashboard Cite

We hypothesized that survival outcomes of WM patients who develop SM is distinct from the general population of individuals who develop those same malignancies. Using the SEER-18 data (2000-2011), we identified patients with cancers of the breast, prostate, lung, colorectum, bladder, melanoma, non-Hodgkin lymphoma (NHL), and acute leukemia, and compared their outcomes according to having antecedent WM or not. The outcome of interest was overall survival (OS), which was analyzed in proportional-hazard models adjusted for age, sex, race, and stage. We found that patients with WM who developed SM were older than population controls with those same cancers. In the multivariate analysis, WM cases with colorectal cancer (HR 1.97; P < 0.001), melanoma (HR 2.63; P < 0.001) and NHL (HR 5 1.35; P 5 0.02) had worse OS than controls with those respective cancers. WM patients with diffuse large B-cell lymphoma also had worse OS (HR 5 1.86; P 5 0.008). The utilization of surgery and radiation was similar between WM cases and controls, except lower rates of prostatectomy and melanoma surgery among WM patients. The survival of WM patients with colorectal cancer, melanoma, and NHL is worse than among general population controls, arguing in favor of age-appropriate cancer screening.

show abstract

“…30 In several studies of transformed lymphoma, ASCT consolidation appears to provide benefit even in the rituximab era. [56][57][58] The benefit of ASCT on patients with double-hit transformation has not been established in these studies, but no doubt a subset of patients included in these retrospective analyses of transformed lymphomas had double-hit lymphoma at the time of transformation.…”

Section: Org Frommentioning

confidence: 99%

How I treat double-hit lymphoma

Friedberg

2017

Blood

Self Cite

120

View full text Add to dashboard Cite

The 2016 revision of the World Health Organization (WHO) classification for lymphoma has included a new category of lymphoma, separate from diffuse large B-cell lymphoma, termed high-grade B-cell lymphoma with translocations involving myc and bcl-2 or bcl-6. These lymphomas, which occur in <10% of cases of diffuse large B-cell lymphoma, have been referred to as double-hit lymphomas (or triple-hit lymphomas if all 3 rearrangements are present). It is important to differentiate these lymphomas from the larger group of double-expressor lymphomas, which have increased expression of MYC and BCL-2 and/or BCL-6 by immunohistochemistry, by using variable cutoff percentages to define positivity. Patients with double-hit lymphomas have a poor prognosis when treated with standard chemoimmunotherapy and have increased risk of central nervous system involvement and progression. Double-hit lymphomas may arise as a consequence of the transformation of the underlying indolent lymphoma. There are no published prospective trials in double-hit lymphoma, however retrospective studies strongly suggest that aggressive induction regimens may confer a superior outcome. In this article, I review my approach to the evaluation and treatment of double-hit lymphoma, with an eye toward future clinical trials incorporating rational targeted agents into the therapeutic armamentarium. (Blood. 2017; 130(5):590-596) Case presentation 1A 53-year-old man presents with a 2-month history of left hip pain. He did not respond to initial conservative management, including rest and physical therapy. Magnetic resonance imaging (MRI) of the left hip was eventually performed and showed a destructive, enhancing lesion involving the left iliac wing, acetabulum, and pubic ramus, measuring 8 3 7 3 7 cm. Computed tomographic (CT) scan of the chest, abdomen and pelvis was then performed, demonstrating enlarged left supraclavicular and right hilar lymph nodes. The soft tissue component of the dominant mass contacted the prostate gland and displaced the urinary bladder. A lucency was also seen in the left T11 pedicle. A biopsy of the bone lesion was performed, revealing a poorly differentiated and pleomorphic infiltrate of large malignant cells, with extensive areas of necrosis. Immunohistochemical stains demonstrated that the infiltrate was CD20 and CD79a positive. This finding was consistent with diffuse large B-cell lymphoma (DLBCL), stage IVA. Clinical risk factors included high-stage, high-LDH, and extranodal disease; performance status was normal, making this high intermediate-risk disease based on the international prognostic index and the age-adjusted international prognostic index.1 Subsequent immunohistochemical stains revealed the lymphoma to be positive for BCL-6, BCL-2, and MYC and negative for CD10, CD30, MUM1, and EBER; the Ki-67 fraction was 50%. This suggests the tumor is of germinal-center origin (using the Hans algorithm 2 ) and a double-expressor phenotype (MYC and BCL-2). The patient was started urgently on standard rituximab, cyclophospham...

show abstract

Transformed non‐Hodgkin lymphoma in the rituximab era: analysis of the NCCN outcomes database

Cited by 65 publications

References 35 publications

Outcomes of transformed follicular lymphoma in the modern era: a report from the National LymphoCare Study (NLCS)

Outcomes of transformed follicular lymphoma in the modern era: a report from the National LymphoCare Study (NLCS)

Survival outcomes of secondary cancers in patients with waldenström macroglobulinemia: An analysis of the SEER database

How I treat double-hit lymphoma

Contact Info

Product

Resources

About